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Patient Forms


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Please click on the links below to download our forms. Please print and complete the forms prior to your appointment and bring them with your insurance card to your appointment. If you are unable to print the forms, please plan to arrive 10-15 minutes early for your appointment so that you can complete them in our office.


Health History Form
Patient Consent Form
Financial Policy Form
Patient Records Access Request Form
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Dr. Todd Paczewski
1500 Wyoming Avenue
Forty Fort, PA 18704
570-287-2500
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