In order to make your first visit a pleasant one, we have several forms to be completed before your appointment. This information will be used to prepare your medical record and to gather information regarding the filing of your insurance.

Please complete the form below and bring them with you to your first visit at our office. Please bring a photo ID, your insurance card(s), and a list of any medications that you are currently taking. All co-pays and co-insurances will be due at the time of check in. We kindly ask that you arrive 15 minutes prior to your scheduled appointment time. If you have any questions or need assistance, please do not hesitate to call our office between the hours of 8:00 AM and 5:00 PM Monday through Thursday, and on Friday 8:00 AM and 1:00 PM.

On behalf of Lung and Sleep Wellness Center, Welcome! We look forward to meeting and fulfilling all of your medical needs. We require a 48 hour cancelation notice when canceling appointments. There is a $50.00 fee for late cancelations and no shows.

Sincerely,

Lung and Sleep Wellness Center

New Patient Form HIPAA NOTICE