Patient Forms
Please print out the requisite forms for your visit. Having these completed prior to your arrival expedites the process and decreases waiting room time.
New Patient Information Packet
To view the forms listed above, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com
Workers’ Compensation Information Packet
- Welcome letter from Dr. Cotler
- Workers’ Comp Information
- Patient Information Record
- Health History Questionaire
- Authorized Use and Disclosure of Protected Health Information Form
- Medication Policy
- Patient Waiver/Consent Agreement to Pay Form
- Notice of Privacy Policies and Practices
- Privacy Notices Signature
