The following forms and corresponding instructions have been provided for your convenience. Please note that these forms may not be the appropriate forms for all patients in all circumstances.
New patients can save time during their first appointment by completing the Patient Registration form prior to their visit. Simply print out the Patient Registration form, fill in the information requested, and bring the completed form with you to your appointment.
(This link will take you outside of the Restorasis website.)
Purpose: This form, Notice of Privacy Practices, presents the information that federal law requires Restorasis Integrative & Functional Medicine to give our patients regarding our privacy practices.
We must provide this Notice to each patient beginning no later than the date of our first service delivery to the patient, including service delivered electronically. We must make a good-faith attempt to obtain written acknowledgement of receipt of the Notice from the patient. We must also have the Notice available at the office for patients to take with them if they request. Whenever the Notice is revised, we must make the Notice available upon request on or after the effective date of the revision in a manner consistent with federal regulations. Thereafter, we must distribute the Notice to each new patient at the time of service delivery and to any person requesting a Notice.
OUR GOAL at Restorasis Integrative & Functional Medicine is to provide you with the highest level of personalized care. We are committed to helping you achieve optimal health. It is important to carefully read the policy information prior to you visit.