Patient Forms

Download & Submit Forms Before Your Appointment

Please click the links below to download our required forms. Complete and email them to dafkokids@gmail.com at least 48 hours before your appointment. Don’t forget to bring your insurance card with you. Please note that treatment cannot be provided without a signed COVID-19 Patient Advisory and Acknowledgment Form.

COVID-19 Patient Advisory & Acknowledgment

Download

Health History Form

Download

Consent Form

Download

HIPAA Notice of Privacy Practices

Download

Over 18 HIPAA Release and Consent Form

Download

Record Release Form

Download

Notice of Privacy Practices Acknowledgement

Download
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