Forms & Information

Before your visit, please download the appropriate form(s), complete, and bring to your appointment. Do not email the form, as it contains personal information.

Dr. Coffey also asks that you review our office policies on privacy, payment, appointments and cancellations, etc.

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Intake Forms

• Permission for Release of Information (PDF doc)
• Brief Background Questionnaire (PDF doc)

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Payment 

• Payment, Credit Card Authorization and No-Show Fees (PDF doc)

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Office Policies and Information

• Notice of Privacy (PDF doc)
• Appointments, Cancellations, No-Show Policy (PDF doc)
• Payment Policies (PDF doc)

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Telemedicine

• Informed Consent for Telemedicine (PDF doc)

Get in touch to make an appointment.

Contact Us