Grayson & Associates

INTAKE FORMS

New-Patient-+-New-HIPPA-(1)-1

New Patient Forms

This form is required to start seeing a Grayson & Associates clinician.

Update to Information Form

This form is required for updating patient information.

84601-Grayson-Info-Update-Sheet-HR
Forms - Request for Medical Records

Request for Medical Records Form

This form is used when you want past medical records from another doctor seen by a Grayson & Associates clinician.

Release of Information Form

This form is required for sending any medical information from Grayson & Associates to another entity.

G&A-ROI-UPDATED-2.8.18

2200 Lakeshore Dr #150, Birmingham, AL 35209
Tel: (205) 871-6926