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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
File

PATIENT REGISTRATION FORM

CLICK HERE to Download File
File

MEDICAL HISTORY FORM

CLICK HERE to Download File
File

FINANCIAL AGREEMENT

CLICK HERE to Download File
OTHER PATIENT FORMS
File

RECORDS RELEASE FORM

CLICK HERE to Download File
File

AUTOMATIC CREDIT CARD PAYMENT CONSENT

CLICK HERE to Download File