McIntosh Clinic’s Release of Information Forms
Below forms are effective as of November 1, 2016.
Coronavirus (COVID-19): Click here to learn how we are protecting our patients, community, physicians and staff.
"I had biopsies and removal of skin cancer. I was pleased with Dr. Barnes's efficiency and competency - the most important things you want in a doctor who is doing surgery on your face. She is warm and caring, which is a huge plus. I'm a repeat customer."
We are currently accepting new patients into our practice. Thank you for considering us. To become a new patient:
When you come to our office for the first time as a new patient, we'll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment.
To make sure there are no delays in care during your first visit experience, please arrive 15 minutes prior to your scheduled appointment to ensure your registration is complete before meeting with your new provider.
Remember to bring:
In an effort to respect the time of all of patients, our staff strives to stay on schedule so that other patients do not have to wait.
For patients who are delayed and arrive late for appointment, every effort will be made to see them the same day. However, wait times may apply, or appointments may need to be rescheduled.
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.