Click the link below, which doctor you are seeing, to print the form.

To save form to your computer: right click the image above and select "save link as".

Please

  • Print the form
  • Fill out the form
  • Bring it to your first appointment or fax to our office at: (717) 393-8540.

Medical Release form

Notice of Privacy Practices

Patients Seeing DR. KAUFMAN

Patients Seeing DR. LOCKEY

Patients Seeing DR. NEJAD

To print, click on the map below for the office where you are scheduled

(Drag your mouse over the icon to view the office)