All new patients complete:

• Patient Registration Forms (2 pages)
• Physician-Patient Arbitration Agreement Form (1 page)

All new patients please download and read this form.
Note: please call for Medicare rates and rates for electronic billing of private insurance. Rates will be higher then the rates listed.

All Medicare patients must also complete the Patient Insurance Information Form (1 page) and include a photocopy of their Medicare card.

To obtain medical records from any other doctor for Dr. Klausner to review please fill out the Authorization To Release Medical Information form (1 page).

All IV patients please complete Informed Consent For Intravenous Nutrient Therapy form (1 page).