If you’re planning your first visit to our office, we look forward to meeting you. To help expedite your check-in or registration with our office personnel, please complete the packet of New Patient Forms below.
Patient Information Form
Patient Signature Form
Medical History Form
Authorization of Release of Medical Information
Please arrive 15 – 20 minutes prior to your appointment so we can properly register you and collect information from you to help Dr. Eyad Y. Baghal with your care.
Listed below are several items we request that you bring to your first visit:
- Completed New Patient Forms as listed above.
- Your insurance card(s), driver’s license or other photo id, and social security number. We must make a copy of your insurance card(s) in order to properly process your claim for you. We require your driver’s license and social security number for identification purposes.
- Any lab test results, films, and copies of medical records you may have. Lab results and images on CDs are particularly important as they will enable your doctor to reach a diagnosis and begin effective treatment more quickly.
- A referral from your insurance plan (HMO) if one is required. We realize that insurance requirements can be difficult to understand, so we encourage you to learn all you can about your plan’s requirements by calling the customer service number on your card. If you still need help, feel free to call the experts in our office who can help ensure that you receive all your entitled benefits.
- A referral from your Primary Care Physician (PCP) to our physician is necessary. This can be as simple as a written note on your primary physician’s prescription form.
- Any questions you may have for your physician. We encourage you to write down your questions so that you do not overlook any. We want you to be informed and will answer your questions so that you fully understand your care and treatment.
We look to meeting you and helping you with your medical needs.
Millennium Gastroenterology, PC Team