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Patient Forms

New Patient Forms needed (age sensitive)

 

Adult - 18 years and olderPatient Forms

 

Children - 17 years and younger Child Forms

 

If you have current x-rays or records please complete this form so that we may obtain your

records prior to your appointment.  Some offices require several days to a week notice to

forward your records so please do this in advance, if possible.  This will allow for your records

to be available in our office on the day of your appointment.

 

Release of records to Dr. Rouse

You may print this form for your records and information only (if desired):

 

HIPAA Privacy Policy

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the contact form below.
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