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Patient Forms

In order to make your visit as easy as possible, we have provided forms for you to fill out prior to your first appointment with us.

Filling these out before your appointment will allow you to spend more time in your consultation instead of filling out paperwork. If you do not have access to a printer or are unable to fill out the forms prior to your appointment, please plan to arrive at least 20 minutes early to allow enough time to finish your paperwork.

In addition to these forms, it is important that you bring:

  • A valid photo ID
  • Your insurance card(s)

Patient Information Form: This form provides us with basic personal and emergency contact information, a brief medical history, and your insurance information. Fill this out in its entirety, and bring it with you to your first appointment.

Patient Information Form

Photo Release Form: Read this form carefully, sign it, and bring it with you to your appointment. This form gives Dr. Bindingnavele the right to use any images taken during your consultation or procedure for educational or other purposes. No personally identifiable information will be attached to these images.

Photo Release Form