| Patient Forms - Express Check In |
| Registration Form (Excel format) Medical Info Form (Excel format) HIPAA Privacy Policy(Excel format) Financial Policy Form (Excel format) |
| New patients to Dr. J Express Care are encouraged to print and fill out the required forms provided below prior visiting us. For Express Check In, please present the completed forms at the reception window when you arrive at our office. |
| Registration Form (PDF format) Medical Info Form (PDF format) HIPAA Privacy Policy(PDF format) Financial Policy Form (PDF format) |
| We now offer 2 types of forms: |
| If you have Microsoft Office Excel Please choose the forms here. |
| If you do not have Microsoft Office Excel Please choose the PDF forms here Note: Medical and Financial Form take a moment to load. |
To fill out the forms in Excel format:
1. Click on the desired Form
2. Saving it to your computer
3. Fill it out on the computer
4. Send the E-mail to the office that
you will be visiting, Either:
Dr J Express Care South
drjsouth@gmail.com
Dr J Express Care North
drjnorth@gmail.com
1. Click on the desired Form
2. Saving it to your computer
3. Fill it out on the computer
4. Send the E-mail to the office that
you will be visiting, Either:
Dr J Express Care South
drjsouth@gmail.com
Dr J Express Care North
drjnorth@gmail.com
To fill out the forms in PDF
format1. Click on the desired Form
2. Print it out
3. Fill it out
4. Bring it in
format1. Click on the desired Form
2. Print it out
3. Fill it out
4. Bring it in
| Note: For your convenience don't spend extra time in the waiting room. Please Print and fill out the forms if you are using PDF, or fill out and E-mail the form in if using the Excel Forms that way we will already have your information ready when you come in. |
