Head Pain Forms

New patients: Please print and fill out all the forms below. Be sure to bring the completed forms with you for your office visit.

Consent, Payment Policy and Payment Agreement

Message Authorization and Acknowledgement of Notice of Privacy Practices

New Patient History

Patient Information

Patient Portal Email Authorization

Privacy Practices


If you are a new head pain patient who will be seeing Dr. Lane, please fill out the Head Pain Intake Form below and bring it to your upcoming office visit.

Head Pain Intake Form


If you would like to authorize the use or disclosure of your Protected Health Information (PHI) to a particular person or entity, please use the form below.

Authorization for Use/Disclosure of Protected Health Information

 

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