Registration Forms

MAKE CHECK-IN EASIER AND FASTER:

  • Bring your insurance card(s) and photo ID to each visit.
  • Bring your medication list and drug allergy list.
    (If you bring a list, you can skip that section on the health form.)
  • Bring the completed forms (below).
  • Bring a referral if your insurance requires one.  (See 'referrals' under the Insurance tab.)

2020 INSTRUCTIONS
We are updating patient health and consent forms this year. 
We are asking ALL Patients to print, complete and sign these patient forms at this time. 
Bring them with you to your first appointment in 2020.  

Print Forms Here:

PRINT Notice of Privacy Practices Acknowledgement of Receipt & Communication Practices (You will find our Notice of Privacy Practices under the Policies tab.)
PRINT Consent to Treat & Assignment of Benefits / Financial Policy
PRINT Health Form

 

Thank You!  We look forward to seeing you!

 

 


 


         

Copyright © 2020 Laura Wagner, MD. All Rights Reserved.
14377 Woodlake Dr. #111 • Chesterfield, MO 63017
314-434-1111