The Authorization to Release/Obtain Information is provided in Acrobat PDF. Please click here to download the form to your computer, print it and then complete and sign the form to give NGNC permission to send /request your medical records or other information to/from entities not associated with NGNC. Once the form is completed, you may mail, fax or bring the form to the office.
The intent in making these forms available for review and completion prior to your appointment is to obtain background and financial information to expedite your new patient process. The completion and return of these forms including the New Patient Packet and Medical Questionnaire does not establish a physician-patient relationship. Please note also that the information on this website is not intended as medical advice and no physician-patient relationship is established until you are seen in the office for your appointment.