Our patient packet is now a two-step process.
All patients should complete PatientLink forms online here.
Once you have completed your online PatientLink forms, please complete the appropriate forms below based on the reason for your visit to Dr. Unsell. Simply click download and then print the forms. Please complete all information to the best of your knowledge. Bring the completed forms with you to your appointment. Also, if you have had previous diagnostic studies like an x-ray, MRI, CT Scan, or EMG please bring a copy of the report and the CD containing any images. This is greatly appreciated and will prevent delays the day of your appointment.
Patient Packet Includes:
- New Patient Questionnaire Form
- HIPAA Notice of Privacy Practices
- Consent for Medication
- Financial Policy
- Authorization for Treatment
- Request for Release of Medical Records
- Health History Form
- Authorization for Release of Information
- New Patient Workers’ Comp Form
Workers’ Compensation Packet Includes:
- Workers’ Compensation Examination Questionnaire
- Disclosure of Physician Ownership