New Patients

Welcome to Lemire Clinic!

We are delighted to have the opportunity to be your health care provider.

Please click here to read our Notice of Privacy Practices as required by HIPAA.

Below are a list of forms that we need for our records. Please download (just click on the form) and print out the forms, fill them out completely, and bring the forms when you come in for your first visit.

Your medical history will be taken when you come in. Also, please bring any prescriptions you are presently taking (bring the actual bottle) as well as a list of vitamins and other supplements you take.

We look forward to seeing you!

Forms

Assignment of Benefits

This is our clinic patient information form which collects all the basic information about the patient, their insurance, etc.

 

NP Request for Medical Records

This is a form that authorizes another provider to release your medical records to us.

 

NP HIPPA Release Form

This form allows you to designate specific people to whom specific medical information can be shared.

 

NP Patient Release Form

Patient Notice: Same day cancellations and all missed appointments are subject to a $45 charge. To avoid this fee please be sure to contact the office at least 24 hours in advance to your appointment.

Thank you!