Patient Forms

 

NEW PATIENT FORMS:

Please download and complete the Patient Intake Questionnaire, Informed Consent Form, HIPAA Notice of Privacy Practices, and, in the case of a telemedicine appointment, the Physical Exam Waiver Agreement.  Please either upload them below or bring them with you to your first appointment.  All information provided is secure.  Please note: Dr. Benedict is not taking new patients in person at this time.

Patient Intake Questionnaire

Informed Consent Form

HIPPA Notice of Privacy Practices

Physical Exam Waiver Agreement

If you have any questions or need assistance, please contact DrB@EastWestHealth.org..

Thank you,

East West Health Team