Forms Required to Begin Care
Thank you for choosing American Sleep Medicine for sleep related disorders. We appreciate your business and know you have many choices. You will find that our Physicians, Board Certified in Sleep, Office Staff, and Technologists are here to help you with a diagnosis and treatment options that best serve you.
Please download and complete our new patient packet.
Although it may seem like a lot, each and every thing we ask is of the utmost importance and helps us determine what is best for you.
Included in this packet:
- Patient Information – This provides us with your general information including insurance coverage.
- Admissions Questionnaire – This provides us with your health history and is an important tool in identifying how we can help you sleep better.
- Patient Consent for Use and Disclosure of Protected Health Information - This form gives you the option to list individuals we can communicate with regarding details about your care or financial obligations.
- Release of Medical Records – This is an optional form. Complete this form if you wish to have us provide your medical records to someone other than your referring physician (we provide your test results to your referring physician automatically). We may ask you to complete this form if we need to obtain more information about your medical history from another provider.
- Minor Patient Authorization – This form is only required if we are treating a patient under the age of 18.
- Notice of Privacy Practices - This is our notice to you of the uses and disclosures of your protected health information and your rights and our duties regarding that information.
- Independent Diagnostic Testing Facility Performance Standards