standard-title Dr. Mikulak Forms

Dr. Mikulak Forms

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

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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

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