FORMS

If you would like to expedite the registration process, please print out and complete the "Patient Registration Form" and "Acknowledgement of Receipt of Privacy Practices" and bring with you on your first visit. Existing patients will require a new form completed every two years or with a change of address. Thank you kindly in advance for your cooperation."

Form Name Form Type / Size
Sinu-Clear, Inc.Brochure - Page 1 , Page 2 pdf / 794K / 1,134K
PATIENT REGISTRATION FORM pdf / 968K
NOTICE OF PRIVACY PRACTICES pdf / 1,031K
PRIVACY PRACTICES- ACKNOWLEDGEMENT OF RECEIPT pdf / 480K
PATIENT MEDICAL HISTORY 1 of 2 pdf / 800K
PATIENT MEDICAL HISTORY 2 of 2 pdf / 719K

PAYMENT POLICY
Sorry, we do not accept any HMO’s at this time, but we do offer discounted cash rates for patients without insurance. We accept cash, checks, and all major credit cards. We also accept most major insurances, and although we are not providers, we will gladly submit your insurance claim. We are participating providers for Blue Cross PPO, Blue Shield PPO, and Great-West Healthcare insurance plans.