Dr. Smith Patient Forms These forms can be downloaded and then brought in at the time of your visit. Just click on one of the links (MS Word Document) and print. Please fill out forms to their entirty with Blue Ink. Medicare Registration Form Medicare Patient History Sheet Financial Disclosure Medicare Patients Notice of Privacy Practice for the new HIPAA Law Notice of Privacy Practice Authorization Form Non Medicare Patient Registration Form -Non Medicare Patient History Sheet -Non Medicare Financial Disclosure Non Medicare Patients -Non Medicare Notice of Privacy Practice For the new HIPAA Law -Non Medicare Notice of Privacy Practice Authorization Form -Non Medicare PREOP/POSTOP INSTRUCTION SHEETS

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