New Patient Forms

Schedule New Patient Visit

 

Thank you for choosing the office of Dr. Rodney Russell.  We believe you’ll find this to be unlike anything you’ve experienced before when it comes to your health.  Please note that we are a cash practice (cash, credit card, HSA/FSA) and we do not file insurance.  Also note that we have a 24 hour cancellation policy.  If you must cancel or need to reschedule, we ask that you call us prior to 24 hours before your scheduled visit to avoid a cancellation fee.  The fees are noted on the New Patient Intake paperwork.

 

*DR. RUSSELL – NEW PATIENT INTAKE

 

The following forms are included in the ABOVE ONLINE NEW PATIENT INTAKE:

NOTICE OF PRIVACY PRACTICE

 

ARBITRATION & INFORMED CONSENT

 

COVID-19 LIABILITY WAIVER

 

The Red Light Therapy form below is only required if you are going to use our Red Light Therapy.

RED / LED LIGHT THERAPY DISCLAIMER