Forms

Payment Policies

We file all insurance plans but ultimately SRI may not be credentialed or in network with your specific plan. Please contact your insurance provider with any questions about your plan, covered services, and in-network/ out of network providers.

Patient Forms

Download All Forms

A “self referral” requires notes on your condition from your primary care doctor or specialist as well as your insurance cards. You can download and print the following forms on your computer at home:

Patient Acknowledgement
Notice of Office Policies
Notice of Privacy Practices
Demographic Form
Authorization Form for Information & Prescription
Records Release Form to Alternate Facility
Records Release Form to Shanahan Rheumatology

To ensure a smooth process, please arrive 30 minutes before your appointment to complete all new patient forms. Don't forget to bring your insurance and identification cards for check-in.

Referral Form

Click the button below to download our referral form.

Download

Forms

Payment Policies

Patient Forms

A “self referral” requires notes on your condition from your primary care doctor or specialist as well as your insurance cards. You can download and print the following forms on your computer at home:

Patient Acknowledgement

Notice of Office Policies

Notice of Privacy Practices

Demographic Form

Authorization Form for Information & Prescription

Records Release Form to Alternate Facility

Records Release Form to Shanahan Rheumatology

To ensure a smooth process, please arrive 30 minutes before your appointment to complete all new patient forms. Don't forget to bring your insurance and identification cards for check-in.

Referral Form

Finding hope, beyond diagnosis.