The Purcell Clinic

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The Purcell Clinic

The Purcell ClinicThe Purcell ClinicThe Purcell Clinic

Signed in as:

filler@godaddy.com

  • Home
  • Our Providers
  • Services
  • Contact Us
  • New Patients
  • Forms

Account


  • Bookings
  • My Account
  • Sign out


  • Sign In
  • Bookings
  • My Account

Patient Forms

New Patient Registration

All New Patients must complete this registration before scheduling their first appointment. Remember, we need a registration for each child! 

Click Here

General Office Policies

All New Patients must acknowledge our General Office Policies. 

This form was updated in November of 2020. 

Coming Soon!

Patient Financial Policy

All New Patients must complete the Patient Financial Policy. If there are any changes for existing patients, please complete this form as an update to a patients account. 

This form was updated in November of 2020. 

Click Here

Consent for Release of Information

This form is used to designate those you want to give permission to access the patients medical information. This form cannot be completed electronically for patient privacy reason. Please use this link to call our medical records team for more information!


Call us!

Controlled Substance Agreement

If your child has been prescribed a controlled substance by our providers, this is a mandatory form. 

Coming Soon!

Sliding Scale Fee Application

Coming soon!
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