New Patient Forms

Here you will find New Patient Forms in a .pdf format. You can print them and fill them out before coming in to the office. This will help us to better serve you.

This form is needed for every new patient. It provides your information, such as name, address, and telephone numbers. There is also a patient health history and authorization for the staff to perform any necessary services during diagnosis and treatment.
We invite you to discuss with us any questions regarding our services.

Doctor Runge submits all x-rays to Radiology Diagnostics, LLC for primary radiological interpretation and report by a specialist. This form acknowledges that disclosure and that the fee for such services will be submitted to patient's insurance company, healthcare carrier, attorney or worker’s compensation carrier for payment.

This form allows us to use and/or share Protected Health Information (PHI) so that we can properly carry out treatment, payment and health care operations.
As with any of these forms, if you have any questions, feel free to call our office.