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Patient Portal

Once you have been provided your personal portal access information, you may click on the button below to securely access your medical record.

New Patient Form

Please bring this completed form to your first appointment. The doctor will review this information with you and it will become part of your medical record.

Insurance Update Form

Please complete this form and bring a copy of your insurance card any time there is a change in your insurance coverage. This will help avoid errors in billing.

Financial Policies

Please read the billing policies and bring a signed copy to your first appointment. 

Privacy Practices

This is the summary of the privacy practices and the handling of protected health information. A complete copy of the privacy practices will be given to you and is available at the office for your review. 

Release of Information

Your medical and financial information is strictly protected above and beyond the requirements of the Health Insurance Portability and Accountability Act (HIPAA). In order to provide the best possible care, it is often helpful to coordinate your treatment with other physicians and mental health providers involved in your care. This form facilitates the transfer of information between providers involved in your care.

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​© 2019 by Shannon Easton-Carr, M.D., Inc.

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