ROBERT J KLEIN, DO

1652 42nd St, NE, Suite A   Cedar Rapids IA (319) 395-0223

Forms



Welcome Letter 2018 - Information regarding appointments, insurance, fees, etc.




Welcome Letter (Medicare) 2018 - Information regarding appointment, fees, etc for Medicare patients




2018 Fee Schedule - 2018 Charges




Notice of Privacy Practices - Office privacy practices




Private Payment Contract 2018 - Medicare opt-out agreement




Registration Form - Patient intake information




History Form - Patient medical history




Authorizations - Patient consent, insurance authorization & acknowledge receipt of Notice of Privacy Practices




Over 18 Authorization - Over 18 authorization to release information to parents, etc



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