Dr. Dunham Family Practice            Board Certified by the American Board of Family Medicine

New & Current Patients

Welcome to your new family medical practice home! Please refer to the list of accepted insurance providers before making an appointment.

If you have already made an appointment to see Dr. Dunham, you can save yourself time by filling out the following forms prior to your first appointment. Please bring copies of the completed forms along a valid driver’s license and your medical provider information card and present to the front desk at time of check-in.

• New Office Policies – Please read completely.

• Patient Information Form – Please print and complete in its entirety. Bring this form with you to your next appointment.

• Patient Medical History Form/Annual Physical Form
 – Please print and complete all 2 pages before your annual physical.

• Office Payment Policy – (Revised January 2015) Please read completely.

• Patient HIPAA Form
– Required by Federal Law. Please read completely.

• Authorization for Release of Medical Records
 – This allows us to move your records to or from the practice.

LAST STEP!!
**Download and complete: SIGNATURE PAGE please print and complete in its entirety before your next appointment. 

Current Patients: Our practice policies have been updated. Please review the above poilicies; print and complete the new signature page and return at your next appointment.