Dr. Mikulak Forms

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

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