Forms

Treatment Contract Policies and Procedures

This form reviews office policies and procedures and is signed as part of working with Dr. Fink.   This form is not for online submission.  It will be reviewed with Dr. Fink in the office.  You can print a copy for your records.

Treatment Agreement PDF August 2015

Release of Information Form

You must sign a release of information form if there is anyone that you would like me to communicate with about you or your child’s care. The release of information form is print only – it cannot be submitted online.   Please open the following link and print as many copies as you need, fill them out and sign them.  They can then be submitted  via US mail, fax, email or in person at your appointment.

Release of Information (Printable PDF)

Appointments and Prescriptions

You may request an appointment or a prescription refill online or by printing and faxing us your request.

Request Prescription Refill Online

View/Print Prescription Refill Request (PDF)

Schedule an Appointment Online

View/Print Appointment Request PDF

Forms to be Filled Out Before First Appointment

The following forms are meant to streamline the process at the first appointment.  They are available in both online and printable versions. Please click the link for the desired form.

Register a New Patient Online

View/Print New Patient Registration Form (PDF)

Complete Patient History Form Online

View/Print Patient History Form (PDF)

Payment Authorization Form

For your convenience you may fill out this form to keep a payment method on file.  This is not an online form – you may print it out and fill in the information and submit it via US Mail, fax, email, or in person at the office.

Payment Authorization Form

Privacy Policy

You can view/print a copy of our privacy policy or request a printed copy from us at any time.

Privacy Policy

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