Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.
"These two Drs, Dr Glass and Dr Kroeger, are the best Doctors around. They and their staff are awesome. Both doctors and the most knowledgeable doctors I know in there feilds, and I have been a nurse for 30+ years and I know alot of Doctors. They are both caring, compassionate, concerned folks and treat you like family. I am proud to say that It is comforting to know that if it is just an office visit or laying on the surgical table I can trust the between God and these two Doctors everything will come out all right. Thank you both!"
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)
Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)