The forms
provided on this page are designed to better serve, and assist
families with easier access to needed information.
NEW
TELEMEDICINE CONSENT FORM
We understand having your little one sick, is not
easy; therefore we would like to help a bit by providing you with this
option to save you time, if you prefer.
*
New patients WILL need
to fill out some of these forms, we would also need you to include
a copy of Insurance card, vaccine
records, and a copy of your ID card. Please send all to
frontdesk@belkysbravomd.com,
FAX, or
Web-upload
if
possible a minimum of three days before
the appointment.
In order to expedite your visit, and minimize
your wait time at our office, we also ask that you please print, fill
out, then
e-mail,
Fax,
or
Web-upload any of the above applicable forms;
or you
may
also
bring
them your next visit. If you need clarification on which forms you
might need, we ask that you please call us.
RIGHTS & RESPONSIBILITIES
MEDICAL HOME CERTIFICATION
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