Forms
New Patient Package
Save time at the office by printing and completing the paperwork before your visit. Includes new patient registration form, health history questionnaire, and HIPAA form (privacy protection).
NOTE: Some of these forms can be completed online BUT be sure to SAVE the form before printing (SAVE button is at the very end of the form.)
Registration Packet NEW 2009 This 2 page form should be printed then completed prior to your visit
Release of information form. This form is optional. Complete it if you would like records from another physician transferred to Dr Hornbake. This form can be filled in online but must be printed and signed.
History Questionnaire. If you are a new patient or have a complicated problem that needs extra attention consider saving time by filling out this form before your visit. This form can be completed online and printed OR sent as an email attachment to Staff.DrHornbake@comcast.net.
Transferring Records
Would you like Dr Hornbake to review your record of previous treatments? This form can be printed, signed and mailed before your visit to the office:
Transferring Records TO Dr Hornbake FROM another physician This form can be completed online but must be printed and signed.
Moving from the area or just spending the winter in a warm spot? Need records sent to another physician? Simply print and complete this form then mail or FAX it to 767-0021:
Transferring Records FROM Dr Hornbake TO another physician
Preventative Services
Wondering what is now recommended for adult preventive services? (Immunizations and screening tests) Recommendations for Preventive Services
Want to keep track of screening tests and immunizations?
Personal Record of Preventive Services