Smith Tower: Fill out & sign online

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Click ‘Get Form’ to open the Smith Tower document in the editor.
Begin by filling out the Appointment Date and Time fields at the top of the form. This ensures your visit is scheduled correctly.
Complete the Registration Form by entering your personal details, including Last Name, First Name, Address, and Contact Information.
Fill out the Medical Questionnaire thoroughly. Answer all questions regarding your medical history and current medications to provide your doctor with essential information.
Review and sign the Financial Policy and HIPAA Compliance forms. Ensure you understand your responsibilities regarding insurance and payment.
Attach any required documents such as your medical/dental insurance card(s) and referral/authorization if applicable.
Once completed, save your document and either print it for in-person submission or send it electronically if allowed.

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