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PLEASE NOTE: This form is not submitted online 2026

The document provides detailed instructions and information for new patients at Dr. Ripperger's clinic, outlining the appointment process, including filling out forms, insurance inquiries, and cancellation policies. It emphasizes the importance of arriving on time, confirming appointments, and understanding financial responsibilities related to treatment. Additionally, it includes sections on patient confidentiality, consent for services, and a self-assessment form to be completed prior to the first visit.

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Begin by accessing the form on our platform. Click ‘Get Form’ to open it in the editor.
Carefully read through the welcome section, which outlines what to expect during your initial appointment.
Fill out the 'Patient Information' section with your personal details, including name, address, and contact information.
Complete the 'Insurance Information' fields if applicable, ensuring you provide accurate policy details.
Proceed to the 'Self-Assessment Form' where you will describe your medical history and current concerns. Take your time to provide thorough responses.
Review all sections for completeness and accuracy before printing. Remember, this form must be printed and brought to your appointment.

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