FOR YOUR VISIT

New Patient Information/Forms:

 

Thank you for choosing to become a patient of the Family Practice of Jeffersonville or Jeffersonville Family & Geriatric Medicine. Please contact our office to schedule your first appointment.

 

In order to save time at your first visit to our office, print and complete the new patient forms (below).

 

Click here to download a PDF with the Patient Demographics Forms

 

Click here to download a PDF with the Patient Medical History Forms

 

Click here to download a PDF with the Financial Policy Form

 

Click here to download a PDF with the Privacy Practice (HIPAA) Consent Form

 

Click here to download a PDF with the Record Release Authorization

​

Scheduling an Appointment:

 

Patients are seen by appointment only. You may schedule appointments during office hours on Monday-Friday by contacting our office at (610) 277-9040. 

 

We truly believe that your time is valuable and make every effort to stay on schedule. However, on some occasions, certain medical situations or emergencies will take precedence. We ask for your understanding in these situations. Similarly, if you should need to cancel an appointment, please call us at least 24 hours in advance.