Patient Forms

Before filling out any surveys, please print and sign

these forms. Bring them to your next appointment with Dr. Alise Jones-Bailey. Thank you.

Cancellation & Refund Policy.docx (pdf)

Download

Consent For Treatment.doc (pdf)

Download

Medical Records Release Form.doc (pdf)

Download

Medication_Supplement List (pdf)

Download

Consent to Receive Text Messages (pdf)

Download

HIPAA Forms (1) (pdf)

Download

Health History Questionnaire (pdf)

Download

Demographic Information (pdf)

Download