Forms

Please click on the appropriate link to download new patient forms and other useful information about our clinic and services. After clicking on the link you will be prompted to open, save, or cancel your download. We recommend that you select the save button allowing you to have control over the information at any time.

If you have selected to save the information to your local hard drive, please give the download time to complete. Download times will vary depending on your Internet connection and traffic at our Web site.

If you experience difficulties retrieving these downloadable files, please do not hesitate to contact us at 727-942-4249 or whitecraneclinic@knology.net.

New Patient Forms
Office Procedures (Word) Office Procedures (Works) Fee and Schedule Information	02/20/2008	1 Page

New Patient Intake (Word) New Patient Intake (Works) Standard Medical Summary	02/20/2008	1 Page

Prescription Release (Word) Prescription Release (Works) Listing of All Current Medications	02/20/2008	1 Page

Privacy Policy Forms (HIPPA)
Summary of Privacy Practices (Word) Summary of Privacy Practices (Works)	02/20/2008	1 Page

Patient Consent Form (Word) Patient Consent Form (Works)	02/20/2008	1 Page

Patient Information Release (Word) Patient Information Release (Works)	02/20/2008	1 Page

Additional Information
Brochure (Word) Additional Information	02/20/2008	2 Pages

Calender (Word) Lectures and Events	09/26/07	1 Page

Family Medicine Chest (Word)	09/26/07	1 Page


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