Forms.

Please complete this brief intake form prior to your first visit. The form can either be emailed back to us at reception@stephenclarkmd.com or you may bring it in with you to the appointment.

Complete the Medical Records Release Form and submit it to your former primary care provider to allow their release of your medical records to my practice. If there are other institutions (specialists, hospitals, ERs, etc) that have records that are relevant to your ongoing care, please submit a separate form to each of those providers or institutions as well.

For tips on utilizing your Out of Network (OON) Benefits, please download Dr. Clark’s helpful guide below.