LVHC New Patient Forms

PLEASE NOTE: All forms are in Adobe Acrobat format, unless otherwise indicated.

TO DOWNLOAD: Right-click and Select "Save As".

NEW PATIENT FORMS
New Medical Patient Forms (with HIPAA Acknowledgment)	These are the forms you will need as a new MEDICAL patient. Please take your time to fill them out and bring them to your first visit.

New Dental Patient Forms (with HIPAA Acknowledgment)	These are the forms you will need as a new DENTAL patient. Please take your time to fill them out and bring them to your first visit.


HIPAA Notice of Privacy Practices	Federal law requires that this notice is to be given to every new patient. Please take your time to read it over. You will be asked to sign a written acknowledgment at your first visit.

Sliding Scale Discount Application	You may be eligible to receive a discounted rate for your visit. Please take your time to fill the application out and bring it to your visit with proof of income.

For all other Forms and Documents, Please go to our Library section.