Amita Sharma Nayyar MD, PC
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Telemedicine Consent Form
Amita Nayyar, MD
Biography
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Patient Information
Notice of Privacy Practices
HIPAA Notice of Privacy and Security Practices
Financial Policy
Insurance and Self Pay details
Patient Follow-up
To be completed by established patients before each Follow-Up Visit.
Policies and Procedures
Please review/print for your records. Contains a broad overview about Office Hours, Messages, Scheduling/Cancelling Appointments, Prescription Refills, Insurance and Fees, Confidentiality, and Record Keeping.
New Patient Medical History
To be completed by each patient PRIOR to Initial Evaluation
Credit Card Authorization
Consent for Telemedicine Visits/COVID-19
This is the release for established parents to complete to give consent to participate in Telemedicine video appointments
Welcome Letter
Welcome Letter for new Patients
Request to Obtain/Release Records
Release of Information Consent form