{"id":594,"date":"2014-04-03T15:41:45","date_gmt":"2014-04-03T20:41:45","guid":{"rendered":"http:\/\/www.nesg.com\/?page_id=594"},"modified":"2023-09-20T14:05:02","modified_gmt":"2023-09-20T19:05:02","slug":"registration-forms","status":"publish","type":"page","link":"https:\/\/www.nesg.com\/index.php\/patient-support\/registration-forms\/","title":{"rendered":"Registration Forms"},"content":{"rendered":"

Located below are our patient registration forms. If you have not been a patient of ours within the last three years, please print all documents and complete accordingly with blue or black ink.<\/h3>\n

Registration Instruction Required (1 Page)<\/a><\/p>\n

New Patient Intake <\/a><\/p>\n

Patient & Responsible Party Info (2 pages)<\/a><\/p>\n

Patient Insurance Info (2 pages)<\/a><\/p>\n

Patient Correspondence Page (1 page)<\/a><\/p>\n

NESG MAP (1 Page)<\/a><\/p>\n

NESG Notice of Privacy Practices – READ, don’t print (6 Pages)<\/a><\/p>\n

NESG Receipt of Notice of Privacy Practices (1 Page)<\/a><\/p>\n

Important Information Regarding Your Appointment (1 Page)<\/a><\/p>\n

SURESCRIPTS CONSENT TO RELEASE FOR TREATMENT PURPOSES (APRIMA)\u00a0(1 Page)<\/a><\/p>\n

CONTROLLED SUBSTANCE INFORMED CONSENT AND THERAPY AGREEMENT 05.2023(1 Page)<\/a><\/p>\n

PATIENT-MEDICATION-LIST (1 Page)<\/a><\/p>\n

\"PDF\"<\/a><\/p>\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Located below are our patient registration forms. If you have not been a patient of ours within the last three years, please print all documents and complete accordingly with blue or black ink. Registration Instruction Required (1 Page) New Patient… <\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"_uag_custom_page_level_css":"","footnotes":""},"class_list":["post-594","page","type-page","status-publish","hentry"],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false,"travelify-featured":false,"travelify-featured-medium":false,"travelify-slider":false,"travelify-gallery":false},"uagb_author_info":{"display_name":"admin","author_link":"https:\/\/www.nesg.com\/index.php\/author\/admin\/"},"uagb_comment_info":0,"uagb_excerpt":"Located below are our patient registration forms. If you have not been a patient of ours within the last three years, please print all documents and complete accordingly with blue or black ink. Registration Instruction Required (1 Page) New Patient…","_links":{"self":[{"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/pages\/594","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/comments?post=594"}],"version-history":[{"count":40,"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/pages\/594\/revisions"}],"predecessor-version":[{"id":989,"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/pages\/594\/revisions\/989"}],"up":[{"embeddable":true,"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/www.nesg.com\/index.php\/wp-json\/wp\/v2\/media?parent=594"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}