Patient Forms

If this is your first time visiting our office, or if you have not been seen in this calendar year, you will need to print and complete our Patient Information Form, Privacy Notice, and Financial Policy Form.

Patient Forms

• Authorization to Release Medical Information
• Patient Information
• Privacy Notice
• Financial Policy

Medical History Forms
Download the patient history form based on your doctor.

• Stephen Cummings, M.D
• Thomas C. Durbin, MD
• Robert T. Grant, MD
• Matthew A. Hopson, DPM
• Jeffrey D. Moore, MD
• Michael B. Potter, MD
• Benjamin R. Proto, DPM
• Lara E. Quinlan, MD
• Allie K. Lewis, PA-C