Download/print the following forms prior to your appointment to save time during your visit to our office. Your demographic form may also be filled out and submitted below.

Patient Demographic Information

This form is for new patients, not established with Beacon P&O, to provide demographic information for our office’s records and the patient’s chart.

Receipt of Notice of Privacy Practices

This form authorizes Beacon P&O to release information needed to determine benefits and for correspondence with physicians or other medical staff involved with his or her treatment. This form is also used as a financial responsibility consent.


This form should be signed after the patient reviews the HIPPA Privacy Practices and before the patient is seen.