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5575 HWY 431 S, #104
Brownsboro, AL 35741
256-469-6487
PATIENT FORMS
(Currently Being Updated)
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Patient Registration
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Patient Rights and Responsibilities
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Financial and Office Policies
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Obtain or Release Medical Records
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Notice of Privacy Practices
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ID Theft Prevention Policy
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Under 14 Patient History Form
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14 and Over Patient History Form
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Authorization Form, Receipt of Privacy Practices, Disclosure Release
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Dr. Pruitt's Patient Information
New Patient?
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