Forms

NCIAP is a non-profit medical care organization setup to provide basic and specialist health care services to uninsured. We make every effort to insure that you may be seen in a timely manner and experience the best care we have to offer. To ensure this, we ask that all patients please follow these guidelines:

• All new patients should arrive 15 minutes prior to their scheduled appointment. Adequate time is needed for paperwork completion.

• We make scheduled appointments for all visits. Walk-in or work-in patients will be accommodated according to the doctor’s schedule.

• For all established patients, we ask that you notify the front office staff of any changes in address, phone numbers, or insurance coverage.

• Please bring a picture ID and any supplemental information which may useful in expediting your visit.

If you are able, please print and fill out the following forms below prior to your visit:

• Registration Form

• HIPAA Form

• Receipt of Notice of Privacy Practices

• Medication Log Form

• Medical History Form

• Release of Medical Records Form

Please ensure that all of these forms are signed and dated.