patient paperwork

New to JBMD? WELCOME!!

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First, Please complete the following :

* New Patient Intake Form (completed form automatically sent to our office) 

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Next, Email the following to :

* Credit Card on File Form (Download the PDF. Be sure to save before sending)  

* Copy of Drivers License and Front/Back of Insurance card 

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Complete the TeleHealth Consent IF you are being see via TeleHealth (completed form automatically sent to our office) 

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New Patient Intake Forms 

Credit Card on File

Click to Download the Fillable PDF File. Once completed, save the form and send to:

  

Thank you!

Release of Information

Patient Portal 

TeleHealth Consent

* This form is to be completed if using TeleHealth services 

Additional Information

*This form is used if you wish to grant  permission for JBMD to share information with another person or office. 

Once a Portal Account is created, you will be able to send the office of Julia Burrow, MD & Associates direct messages, request an appointment, view past and future appointments, pay a balance and request a prescription refill.

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