• Home
  • About Us
    • Howard E. Feingold, MD
    • John Fox, MD
    • Annette Hils, MD
    • Marci Johns, APRN
    • Ana May, MD
    • Daniel A. Nosek, MD
    • Christina Taylor, APRN
    • Michael P. Wanger, MD
  • Services
    • Outpatient and Inpatient
    • Remote Patient Monitoring
    • Chronic Care Management
    • Prevention and Wellness
    • Diseases and Conditions
  • Contact / Location
    • Contact Us
    • Jeffords Location
    • Lakeview Location
  • Forms and Policies
    • Office Visit Forms
    • Policies and Forms
  • Patient Portal
  • Bill Pay
  • More
    • Home
    • About Us
      • Howard E. Feingold, MD
      • John Fox, MD
      • Annette Hils, MD
      • Marci Johns, APRN
      • Ana May, MD
      • Daniel A. Nosek, MD
      • Christina Taylor, APRN
      • Michael P. Wanger, MD
    • Services
      • Outpatient and Inpatient
      • Remote Patient Monitoring
      • Chronic Care Management
      • Prevention and Wellness
      • Diseases and Conditions
    • Contact / Location
      • Contact Us
      • Jeffords Location
      • Lakeview Location
    • Forms and Policies
      • Office Visit Forms
      • Policies and Forms
    • Patient Portal
    • Bill Pay

  • Home
  • About Us
    • Howard E. Feingold, MD
    • John Fox, MD
    • Annette Hils, MD
    • Marci Johns, APRN
    • Ana May, MD
    • Daniel A. Nosek, MD
    • Christina Taylor, APRN
    • Michael P. Wanger, MD
  • Services
    • Outpatient and Inpatient
    • Remote Patient Monitoring
    • Chronic Care Management
    • Prevention and Wellness
    • Diseases and Conditions
  • Contact / Location
    • Contact Us
    • Jeffords Location
    • Lakeview Location
  • Forms and Policies
    • Office Visit Forms
    • Policies and Forms
  • Patient Portal
  • Bill Pay

New Patient

If you are 65 years old or older, please complete these forms

New Patient Medical Packet (Age 65 and older) (PDF)Download
New Patient Registraion Packet (PDF)Download

If you are 18 through 64 years old, please complete these forms

New Patient Medical Packet (Age 18 thru 64) (PDF)Download
New Patient Registration Packet (PDF)Download

If you are 17 years old or younger, please complete these forms

New Patient Medical Packet (Age 17 and younger) (PDF)Download
New Patient Registration Packet (PDF)Download

If you are 18 through 64 years old, please complete these forms

Established Annual Well Exam Packet (Age 18 thru 64) (PDF)Download

Established Patient

If you are 65 years old or older, please complete these forms

Established Patient Annual Well Exam Packet (Age 65 and over) (PDF)Download

If you are 17 years old or younger, please complete these forms

Established Annual Well Exam (Age 17 and younger) (PDF)Download

Miscellaneous Forms

Handicap Parking Pass (PDF)Download
Living Will/Medical Power of Attorney (PDF)Download
Medical Records Request (Lakeview Office) (PDF)Download
Medical Record Request (Jeffords Office) (PDF)Download
Pelvic Exam Consent (PDF)Download

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