standard-title Dr. Mikulak Forms

Dr. Mikulak Forms

Coming To See Dr. Mikulak and Physician’s Assistant: Michael Walker, MS, PA-C

dr_mikulak_pa_walker

Download, Print, and Complete These Forms Prior To Your First Visit…

1) Patient Information Form

2) Medical Information Release Form (HIPAA)

3) Patient Financial Agreement

4) Initial Visit History

4) Initial Visit History

5) Patient/Physician Contract

6) No Show Policy

Remember to bring the following items:

  • X-ray, MRI, EMG or other studies
  • Operative reports
  • Diagnostic test results
  • Insurance information
  • Current list of medications
  • Photo identification