Online Forms

Questionnaire

A medical history and questionnaire about the injury/problem.

New Patient Registration Form

Patient information, insurance information and financial policy for in-network insurance patients.

HIPAA Policy Acknowledgement

Acknowledgement of HIPAA policy and instructions/permission to disclose health information.

HIPAA Notice
A four-page condensed version of the HIPAA privacy act. Please read before signing the HIPAA Policy Acknowledgement form.
Required for out-of network patients only:
Out-of-Network Financial Policy
An explanation of out-of-network or cash-pay financial policy

Discrimination is Not Tolerated in This Medical Practice

In accordance with the ethical standards of the medical profession, Lamont J. Cardon, MD
complies with applicable Federal civil rights laws and does not discriminate on the basis of
race, color, national origin, age, disability, or sex. Our practice also does not exclude people or
treat them differently due to race, color, national origin, age, disability, or sex.
For a more detailed look at our policy, and a list of our services click the link below.

Does-Not-Tolerate-Discrimination.pdf