EXISTING PATIENT FORMS

CREDIT CARD
AUTHORIZATION FORM

If you are an existing client, and need to update your credit card authorization form, please click on the credit card authorization form button. Please fill out all required fields and click submit.

CREDIT CARD AUTH FORM

HIXNY ELECTRONIC DATA ACCESS CONSENT FORM

By signing this consent form, you are allowing the providers who you see in this practice to access your medial records electronically through HIXNY. Checking “I Give Consent” and signing your name will allow us to quickly get information from labs or other doctors you see as part of your treatment — so you don’t have to worry about remembering details from other visits or make calls and request information is sent over to us. Please fill out the requird fields and click submit.

HIXNY ELECTRONIC DATA ACCESS CONSENT FORM

PRESCRIPTION REFILL REQUEST

For medication/prescription refill requests, please click on the prescription refill request button. Please fill out all required fields and click submit. Please allow up to 72 hours for all medication/prescription refill requests.

PRESCRIPTION REFILL REQUEST FORM