Patient Information & Forms
If this is your first time with us, we have made it easy for you by providing our health related forms online.
All forms are available online. If you would please select the appropriate form(s). Print them out and bring the completed forms with you to your appointment. We have chosen to offer you this option to print the forms in advance, thus you will be able to complete them at your own convenience and in the comfort of your home. Please print on white paper only.
Existing Patient Forms
- Assurant Health
- BCBS of Alabama
- Golden Rule
- Health Spring
- PBI/Gordon Corporation
- Physicians Mutual
- Railroad Medicare
- Tricare for Life
- Tricare South/Humana Military
- Tricare West
- United Health Care
Note: It is always best that you call your insurance plan to check that Dr. Chen is a preferred provider on the plan. All co-pays and deductibles are due at the time of the visit.
It is the policy of Dr. Chen that medical or other information concerning any patient will not be released to any outside person or agency without the signed consent and authorization of the patient except in those instances where it is necessary for the continuation of care or required by law. Such information will be released only to the person or agency specified in writing by the patient.
Signed copy of the release form will be placed in the patient’s medical record. As mandated by the Health Insurance Portability and Accountability Act (HIPAA), ALC Consulting, LLC has a notice of Privacy Practices that is readily available via this Internet Web site and/or on hardcopy within our medical office.