Patient Forms


Patient Forms

Please click on the links below to download our forms. Please complete the forms and email them to dafkokids@gmail.com at least 48 hours prior to your appointment. Please bring your insurance card to your appointment. Please note that if a signed COVID-19 Patient Advisory and Acknowledgement form is not submitted, you will not be able to be treated.


COVID-19 Patient Advisory & Acknowledgment
Health History Form
Consent Form
HIPAA Notice of Privacy Practices
Over 18 HIPAA Release and Consent Form
Record Release Form