Patient Forms

Please click on the links below to download our forms. Please complete the forms and email them to dafkokids@gmail.com at least 48 hours prior to your appointment. Please bring your insurance card to your appointment. Please note that if a signed COVID-19 Patient Advisory and Acknowledgement form is not submitted, you will not be able to be treated.

COVID-19 Patient Advisory & Acknowledgment

Health History Form

Consent Form

HIPAA Notice of Privacy Practices

Over 18 HIPAA Release and Consent Form

Record Release Form

Notice of Privacy Practices Acknowledgement

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