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Deborah Drumm APRN, BC - Forms

On this page you can access and download the various forms and documents you will need.

Form: Patient Info Sheet
Description: Your personal information that I must have on file
Download: Patient Info Sheet.pdf

Form: Adult Consent Form
Description: Consent for a competant adult to receive treatment and/or medication
Download: ABC.ConsentsToTreat.19-18-12.pdf

Form: Release of Information
Description: Patient consent for practioner release/exchange of relevant information
Download: DD's release of info.29-18-12.pdf

Form: Medication Chart
Description: Helpful chart to assist patient in tracking/scheduling medications
Download: DD.Medication Chart.19-18-12.pdf

Form: Getting The Most From Your Insurance
Description: Instructions on how to deal with your insurance company
Download: ABC.Getting the Most from Your Insurance2015.pdf

Form: New Patient Letter
Description: Policy document addressing sessions, payments, cancellations etc. that you must sign and submit
Download: Dear New Patient Letter 4.15-1.pdf

Form: A Statement Of Wishes In The Event Of Death
Description: A helpful form that helps any smart individual be prepared
Download: A Statement Of My Wishes In The Event Of My Death.pdf

Form: Office Policy Letter
Description: Letter Explaining Office Policies
Download: New Office Policy Letter 12-11-12.pdf

Form: Hippa Form
Description: HIPPA Release Form
Download: ABC.HIPPA.19-18-12.pdf

Form: Records Release Form
Description: For me to speak with other health care providers
Download: ABC.RecordRelease.19-18-12.pdf

Form: Insurance Info Advice
Description: Some helpful tips
Download: INSURANCE INFO.Advice9-18-12.pdf

Form: Insomnia
Description: Helpful information about insomnia
Download: Insomnia.pdf

Form: Use Of Essential Oils
Description: From The Kings Medicine Cabinet
Download: Josh-Axe-The-Kings-Medicine-Cabinet.pdf