For your convenience, we have a couple of options that will allow you to provide your patient information to DSC. One option is using our online portal; the other is to download forms on this web site, fill them out at home and then give the forms to our receptionist on your visit. The instructions below will provide guidance to new patients and to exisiting patients.

For new patients…

For existing patients…

On your first vist, you will need to complete the following the following forms, either online or usings the forms below. You will also need to read other forms listed:

Required Forms

Patient Registration Form Form Online
Medical History Form Form Online
Signature Form Form X
HIPAA Release Form X
Acknowledgement of Receipt of Notice of Privacy Practices Form X

Optional Forms

Credit Card Payment Form Form X

Review these forms

Patient Privacy Form Form X
Office Policy Form Form X

If you need to transfer your medical records to our office, please complete the Medical Records Release Form.

If any of your original information changes or you have updates to your insurance of medical history, you can use the following to update:

Required Forms

Patient Information Change Form Form Online
Medical History Form Form Online
HIPAA Release Form X
Signature Form Form X
Release of Information to new provider, when moving  Form

Optional Forms

Credit Card Payment Form Form X

Existing patients may wish to review the Patient Privacy Form as well as our Office Policy Form prior to your visit.

Patient Portal Instructions

When you make an appointment with DSC, ask for your private security code to get setup online. You will use your security code on your first login and then make your own user name and password. From that point forward, you will login with only your user name and password. Once you have logged in to the portal, you may edit your demographic and insurance information as well as your past medical history. Please ensure that you click the Save button at the bottom of each screen to save your information. Patient Portal

Click Finalize to submit your updates to our office.  We will review this information with you at your next appointment.  Please review your portal information prior to each appointment to make sure it is up to date. Rest assured that all information provided is confidential, secure and HIPAA compliant.   Please call the office at 704-943-3714 if you have any questions.

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