Forms

New Patients Welcome Packet

Instructions:

  • Step 1 – Please download the medical form(s) to your computer.
  • Step 2 – Fill out the appropriate form fields shown on the PDF.
  • Step 3 – Choose “File” > “Save” to ensure your information is saved on the PDF form.
  • Step 4 – Print the form(s) and bring to the office at your appointment time.

Welcome Letter – Welcome to Natesan Medical Group!  We would like to take this opportunity to thank you for choosing our physicians to participate in your healthcare. We look forward to providing you with personalized, comprehensive health care focusing on wellness and prevention.

  • New Patient Form – This form allows us to collect the personal/healthcare information we need to better serve you as a patient.  Understanding any existing medical conditions, illnesses or challenges new patients are facing will help our physicians cohesively partner with other specialists to diagnose, treat, and provide extensive patient centered healthcare services.
  • Privacy Practices – The purpose of our Privacy Practices form is for you to understand your health record and health information rights.  This includes disclosures for treatments, payment processes and health operations such as authorization to share medical records and your right to complain if you believe your privacy rights have been violated.
  • Policies – Our policies include information on the protocol for accessing records and the forms of payment that are accepted.  This form also states that all unpaid services will be sent to a legal collection agency for collection.
  • Release Form – The release form provides guidance and the approval for accessing medical records from another physicians’ office.

Current Patients

Instructions:

  • Step 1 – Please download the medical form(s) to your computer.
  • Step 2 – Fill out the appropriate form fields shown on the PDF.
  • Step 3 – Choose “File” > “Save” to ensure your information is saved on the PDF form.
  • Step 4 – Print the form(s) and bring to the office at your appointment time.
smiling team of doctors nurses, and physicians posing