Patient Information Forms

This page contains documents and links to other web sites may be useful for patients to review before your first visit to our office. Click on a link below to open the document in Adobe PDF format or to visit one of the web sites.

- click to download the free Adobe PDF Reader

Patient Demographic Form

Patient History Form

Message Consent Form

Patient Notice of Privacy

HIPAA Document
Please read the HIPAA Document.

HIPAA Signature Page
Please print, sign and bring to the office.

Other Forms

Patient Authorization Form
Authorization to Use or Disclose My Health Information.

• Susan G. Komen Breast Cancer Foundation
• Dr. Susan Love Website for Breast Cancer
• Clear Creek Surgery Center