Forms - The Doctor Is In - Full Service Medical Care

PATIENT FORMS:

Patient Registration (new patients must complete, existing patients are required to update their information yearly)

Medical Records Transfer Request Form (complete if you need your records sent to our office or to request your records be sent to another provider)

Insurance Payment Policy Form

The Doctor Is In Notice of Privacy Practices

OCCUPATIONAL/WORKER'S COMPENSATION CLIENTS

EXISTING CLIENTS

Authorization for Treatment (this form must be signed by the employer and be sent in with the employee or faxed to the treating office with each visit)

NEW BUSINESS CLIENTS

Employer Welcome Letter (Outlines some of the services we provide and directions for opening an account with The Doctor Is In)

Employer Profile (Complete this form to set up a new Account)

Authorization for Treatment (this form must be signed by the employer and be sent in with the employee or faxed to the treating office with each visit)

Clinton Office: 59 Old Highway 22, Clinton, NJ 08809 Tel: (908) 730-6363 Fax: (908) 730-8185
Flemington Office: 149 M Highway 31, Flemington, NJ 08822 Tel: (908) 782-7700 Fax: (908) 782-3644
Phillipsburg Office: 1205 US Highway 22, Phillipsburg, NJ 08865 Tel: (908) 213-2211 (908) 213-9913

Business Office: 149 M Highway 31, Flemington, NJ 08822 Tel: (908) 782-7700 Fax: (908) 782-2446