Online Patient Forms
Prepare for your visit
Streamline your experience and ensure all your information is ready for discussion. Simply select the forms you need below and bring the completed documents to your appointment or e-mail them to us from our contact form.
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MSQ Form
This form helps assess your current health by identifying and tracking symptoms to guide personalized care. Please e-mail to info@drlepine.com once completed.
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Patient Privacy Form
Your privacy is our priority; this form outlines how your medical information is protected and shared.
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Informed Consent Medical Form
This form ensures you understand and agree to the proposed medical treatments and their potential risks and benefits.
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Medicare Private Contract Form
DO NOT fill this out unless you have Medicare. This form outlines the agreement for private payment of medical services not billed through Medicare.
