Forms

Welcome to the Offices of Dr. Janet A. Betchkal M.D. P.A.

Please complete the following New Patient Forms prior to arriving at the office for your appointment.

• Patient Information and Privacy Policy

  PDF

• Notice of Privacy Practices

  PDF

• Patient Acknowledgment of Receipt of Notice of Privacy Practices & Designation of Authorized Persons)

  PDF

• Revocation of Authorization to Release Protected Health Information)

  PDF