NEW PATIENT INFORMATION PACKET:
Please fill out the following forms and bring them with you on your first visit:

Welcome letter from Dr. Cotler [pdf]
Patient Information Record [pdf]
Health History Questionaire [pdf]
Authorized Use and Disclosure of Protected Health Information Form [pdf]
Medication Policy [pdf]
Patient Waiver/Consent Agreement to Pay Form [pdf]
Notice of Privacy Policies and Practices [pdf]
Privacy Notices Signature [pdf]


WORKERS’ COMPENSATION PATIENT INFORMATION PACKET:
Please fill out the following forms and bring them with you on your first visit:

Welcome letter from Dr. Cotler [pdf]
Workers’ Comp Information [pdf]
Patient Information Record [pdf]
Health History Questionaire [pdf]
Authorized Use and Disclosure of Protected Health Information Form [pdf]
Medication Policy [pdf]
Patient Waiver/Consent Agreement to Pay Form [pdf]
Notice of Privacy Policies and Practices [pdf]
Privacy Notices Signature [pdf]

If you have any additional questions, please feel free to contact our office at 713-523-8884.


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