​Patient Information and 
Policies Form

Please print this form, fill it out and bring with you at the time of your appointment.  This form must be updated in our office EVERY12 months or when any information changes.  Please read all policies in detail.  We will be happy to answer any questions.

New Patient Medical History

Please print this form, fill it out and bring with you at the time of your appointment.  We must have a complete medical history on every patient. Completing this form prior to your arrival will help reduce your wait.

Patient Medical UPDATE Form

Please print this form, fill it out and bring with you at the time of your appointment.  We must have an updated medical history at EVERY patient visit.  Completing this form prior to your arrival will help reduce your wait.
Genetic Survey​
​Please click the link to complete the genetic survey and submit the information.  The submitted information will transmit directly to our office for our physicians to determine if you qualify for genetic testing based on family history.  Testing is not dependent on family history of breast cancer only.  Other types of cancers affect qualification.  Our physicians will discuss qualification with you in detail at the time of your visit. 

Financial Assistance Opportunity

We are happy to now offer our patients financial assistance options through both Advance Care Card and Parasail Financial to help with out of pocket medical expenses (co-pays, co-insurance and deductibles).  Both companies work with various lenders to provide interest free payment terms for payment of medical expenses as well as medical loans.  Applying is quick and a response is obtained instantly.  To apply please click the buttons below.  Advance Care button below.  If you have questions or need assistance please call our office at 205-930-0806 or call Advance Care direct at 800-432-9470.