New Patient Forms
For your first appointment, patients must bring the New Patient Registration Forms AND the New Patient Medical History/Intake Form for the physician they are seeing.1. ALL PATIENTS: Print out and complete New Patient Registration Forms (4 pages)
2. Dr. Feuer’s Patients Only: Print out and complete New Patient Medical History/Intake Form (6 pages)
3. Dr. Glasgow’s Patients Only: Print out and complete New Patient Medical History/Intake Form (6 pages)
You will need to bring to your first appointment, the following:
- Completed New Patient Registration Forms
- Completed Medical History/Intake Forms
- List of all your current prescriptions and over-the-counter medications
- Medical insurance card
- Photo ID
If you are unable to print or need assistance with the forms, we ask that you please arrive at our office 30
minutes prior to your scheduled appointment time.
Existing Patient Forms
We request that you please download and complete the Registration Form below if any of the following applies
- Your appointment will be your first one this calendar year
- You have had a change in address, phone number, or medical insurance since your last visit
Medical Records Release
If you would like a copy of your medical records, please complete the Medical Records Release Form below.
Medical Records Release Form
Consent to Communicate with Designated Individuals Form (Optional)
If you would like your spouse, family members or other caregivers to communicate verbally with AGO
about your care and treatment, please complete this form below.
Consent to Communicate With Designated Individuals Form