PATRICIA TANYA WADE MD LLC

Available Forms

Demographics Medical Information Release and Assignment of Benefits Methods of Contact New Patient Questionnaire OFFICE POLICY FOR PATIENTS AND FAMILY MEMBERS Pre Office visit Questionnaire Televisit Consent Form Terms of Receiving Test Results

OFFICE POLICY FOR PATIENTS AND FAMILY MEMBERS

Patricia T. Wade, M.D. LLC

Terms of receiving CONSULTATION/VISIT:

It is the policy of this office that DUE TO COVID 19 the patient will come to the office alone unless he/she needs a family member to interpret or physically assist due to disabilities . ONLY ONE PERSON WILL ALLOWED IN THE OFFICE WITH THE PATIENT IF NEEDED.

I acknowledge and agree to this policy. I understand that I must WEAR A FACEMASK to the appointment in order to receive CARE AT THIS FACILITY.

Patient Initial

Date

Patient Name (PLEASE PRINT)

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