For your convenience, we’ve bundled our forms into one PDF document. To save time on your first visit, simply complete the following form and bring it to your first appointment. If you are unable to view this form, please download the latest version of Adobe Reader®.
The Patient Medical Information Forms request the following information:
- Patient Health Information Record
- Temporomandibular Joint (TMJ) Pain Questionnaire
- Airway Questionnaire for Obstructive Sleep Apnea (OSA)
Research shows that when patients know what to expect from surgery, it leads to:
- Significant reduction in anxiety
- Earlier discharge
- Less pain medication requirements
- Significant improvement in the recovery process
Therefore, please review the following preoperative and postoperative information to assist you with the stress management of your surgery.
Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) Requirements
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires that we provide you with this notice of our privacy practices and legal duties, as well as your rights, regarding any of your protected health information (PHI) that we maintain. Dr. Larry M. Wolford, DMD, Oral and Maxillofacial Surgery, will follow the privacy practices that are described in this notice, and will also comply with any stricter federal or state laws that may apply.
Larry M. Wolford, DMD, Oral and Maxillofacial Surgery, reserves the right to change our privacy policies and to amend this notice from time to time. Updated copies of our Notice of Privacy Practices may be obtained from our website at drlarry.mach1design.com.