PATIENT FORMS
To expedite your check-in process and ensure the accuracy of your information,
PLEASE COMPLETE the pre-registration forms prior to your visit.
You may FAX them to our office @ (256) 231-1324 or email to SmithMDOffice@cableone.net.
OFFICE VISIT PRE-REGISTRATION FORMS
PATIENT REGISTRATION FORM
CLICK HERE to Download FileMEDICAL HISTORY FORM
CLICK HERE to Download FileFINANCIAL AGREEMENT
CLICK HERE to Download FileOTHER PATIENT FORMS
RECORDS RELEASE FORM
CLICK HERE to Download FileAUTOMATIC CREDIT CARD PAYMENT CONSENT
CLICK HERE to Download File