Patient Medical History Form
Patient Intake Form Financial Consent HIPPA
Therapy Insurance Information Form HIPPA
Medicare Cap Medicare Secondary Insurance
Advance Beneficiary Notice Of Noncoverage (ABN)
Patient Information Letter
X-Ray Release Form
INSTRUCTIONS IF USING OUTLOOK
1. Open the form
2. Fill out the form
3. Click submit form (Outlook will open with the form attached)
4. Click send
5. Print if necessary
INSTRUCTIONS IF USING POP3 EMAIL (Yahoo, Gmail, Hotmail, Etc.)
1. Right click the form and choose Save Target As
2. Save the file to the desktop
3. Fill out the form
4. Click save (you do not need to click the ‘Submit Form’ button)
5. Open up your email software of choice
6. Compose a new email to patientinfo@handandmicro.com
7. Attach the form
8. Click submit in your email client
9. Print the form if necessary