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Forms

To help us to serve you better and limit your waiting time in the office please print out the forms below and have them completed for your appointment. If you have any questions while filling out the forms please feel free to call the office of your appointment.

  1. Patient Information Sheet
  2. Authorization for Insurance Billing
  3. Financial Responsibility
  4. HIPPA
  5. Approved List of Persons
  6. LymphaTx HIPAA Notice of Privacy Practices
  7. LymphaTx HIPAA Acknowledgment of Receipt of the Notice of Privacy Practice
  8. Photo Consent
  9. Medications Form