Patient InformationSimplify the front office paperworkThis form can simplify paperwork for the front office. It provides sections for general information and responsible party details; suitable for adults and children. For patients with insurance, primary and/or secondary insurance information can also be noted. The authorization section allows for assignment of benefits, "signature on file", general consent (Click on Informed Consent Forms for more information), and information release. This authorization can also be photocopied and attached to an insurance claim form. FORM FEATURES
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