immix 479.795.1101

Patient Information

For your convenience, we have made our new patient forms available in .pdf format you can print the forms and bring them into the office with you.

We recommend printing and completing these forms at home. Please bring your completed forms with you for your first appointment.

If you have any problem getting these files to print properly, please call or email our office and we will gladly send or fax them to you.

Medical and Dental History

Patient Registration

Notice of Privacy Practices [view/read here]

Notice of Privacy Practices Acknowledgment

Payment and Insurance Info

Procedure Consent

We accept the following insurances:

We accept all insurance policies and will file both in and out of network claims.
We accept Cash, Check, Credit/Debit Card and Care Credit