Patient Forms - Rejuvinix
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Patient Satisfaction

We continue to strive for patient and medical excellence. Your feedback is a vital component to help us improve our care of you.

Patient Survey
Patient Information Form

We like to get to know you; this helps speed up the process.

Patient History
HIPAA

Your health information is yours and we do everything we can to protect it.

HIPAA Patient Consent Form
Authorization For Release of Medical Records

Fill out this form before coming in to speed up the process and see you as soon as possible.

Medical Record Authorization Form
Patient/Client Rights and Responsibilities

Fill out this form before coming in to speed up the process and see you as soon as possible.

Patient/client Rights And Responsibilities
Financial Policies

Fill out this form before coming in to speed up the process and see you as soon as possible.

Patient History
Patient Consent Form

Fill out this form before coming in to speed up the process and see you as soon as possible.

Patient Consent Form
Cancellation Policy

Prior to canceling an appointment, please review our cancellation policies.

Cancellation Policy
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