shawnadeevesmd.com

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PATIENT PORTAL

shawnadeevesmd.com

shawnadeevesmd.com shawnadeevesmd.com shawnadeevesmd.com
Home
Services
Policies & Information
Patient Forms
PATIENT PORTAL
More
  • Home
  • Services
  • Policies & Information
  • Patient Forms
  • PATIENT PORTAL
  • Home
  • Services
  • Policies & Information
  • Patient Forms
  • PATIENT PORTAL

PATIENT FORMS

Please contact our office to set up a Patient Portal. You will need to fill out the forms below on the portal. 

Check out the PATIENT PORTAL page for more information and answers to Frequently asked Questions.

If you are having trouble with that process you can Print and Sign the PATIENT DOCUMENTATION PACKET below and then Fax the document to (210) 888-1449 

(Please do this only as a last resort.)


NOTE: 

Prior patients and current patients need to do this as well if this is your first visit to my new location.  

DOWNLOADABLE PATIENT FORMS

PLEASE DOWNLOAD AND RETAIN THE FOLLOWING DOCUMENTS

They are Signable through the Patient Portal. Contact my office to get set up with a Patient Portal account.

PATIENT DOCUMENTATION PACKET (pdf)Download
CONSENT FOR TREATMENT (pdf)Download
CLINIC POLICIES & PROCEDURES (pdf)Download
PATIENT AUTHORIZATION FOR PAYMENT (pdf)Download
CLINIC TELEMEDICINE POLICIES AND AGREEMENT (pdf)Download
SUMMARY NOTICE OF HIPAA PRIVACY PRACTICES (pdf)Download
HIPAA RELEASE FORM (pdf)Download
PATIENT INFORMATION SHEET (pdf)Download
INSURANCE ACKNOWLEDGMENT (pdf)Download

SUBMITTING INSURANCE INFORMATION AND ID

Patients with Insurance:

Please send a copy/photo of your ID card and a copy/photo of the front and back of your insurance card to

admin2@shawnadeevesmd.com

Patients without Insurance / Self Pay:

  Please send a copy/ photo of your ID to admin2@shawnadeevesmd.com

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  • Services
  • Policies & Information
  • Patient Forms
  • PATIENT PORTAL

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