First Office Visit

Please complete the following forms and bring them with you to your first visit. If you are currently taking any medications or supplements please bring those with you to the first appointment, as well as copies of any recent labwork.

Remember to visit the Notice of Privacy Practices page and the Email Policies page.

Insurance: It never hurts to try to submit for reimbursement. In lieu of directly billing your insurance provider Dr. Potter can provide you with a superbill at the end of your visit which you can submit to your insurance company. It is up to you, the patient, to determine insurance coverage.

Intake_Form
Release_of_Records
Insurance_Worksheet

 

Download Instructions

To view the PDF inside your browser  just click on the download button. If you want to save the document directly without viewing it first you can use your browsers right-click option. It will say something such as: "Download linked file as...".

Dr. Potter’s office is a Fee For Service Clinic. Personal checks and debit/credit cards are accepted.