Registration & Referral Forms
Below are the forms for new patients at Regina Hill, MD, Inc. These forms can be printed by clicking on the form itself and then clicking the print button in the upper left hand corner. If you are unable to open the forms, please click here to download Adobe PDF Reader.
Filling out the forms prior to your visit will save time when you arrive at our office and assure you are seen more promptly. Please print the forms, fill them out, and bring them with you on the day of your first visit.
Thanks again for giving us the opportunity to take care of you.
New Patient Registration Form
The New Patient Registration Form is your opportunity to provide us with the personal information required by Regina Hill. This includes your name, contact information, and insurance information.
Health History Form
The Health History Form is your opportunity to tell us about your prior medical history.
Financial Policy Form
The Financial Policy Form is an agreement between you and our office on the process of insurance reimbursement.
Informed Consent For HPV Testing Form
The Informed Consent For HPV Testing Form is required before HPV testing.
Notice of Privacy Practice
The Notice of Privacy Practice document describes how medical information about you may be used and disclosed, and how you can get access to this information. Your acknowledgement is required by completing the Privacy Practice Acknowledgement Form.
Privacy Practice Acknowledgement Form
The Privacy Practice Acknowledgement Form indicates acknowledgement of the Notice of Privacy Practice document.