Services

Forms

*Please print your intake and other 5 sheets*

To save time at our first visit please print out the appropriate intake form, and the rest of the forms that follow. Thanks!

• Intake-child  http://drjenniferash.com/PediatricHealthIntake.doc

(Intake form for children coming in as new patients)

• Intake-adult  http://drjenniferash.com/AdultHealthIntake.doc

(Intake form for adults coming in as new patients)

• Privacy practices acknowledgement http://drjenniferash.com/AcknowledgementPrivacyPracticesupdated.doc
• Financial policy  http://drjenniferash.com/FinancialPolicyupdated.doc
• Informed consent http://drjenniferash.com/Informedconsent.doc
• Patient information  http://drjenniferash.com/PatientInfo.doc
• Copy for you to keep of our privacy policy http://drjenniferash.com/PrivacyPractices.doc

If you will be using insurance for your visit please verify your coverage prior to your visit.

Please note our receptionists Angela or Beth will also need to make a copy of your insurance card at our first visit.

On call access

All patients will have access to Dr. Ash's cell phone number to be used in case of medical emergency.  Dr. Ash will remain on call for her patients at all times. When Dr. Ash is not available, coverage will be provided by another physician. Please be respectful of Dr. Ash's time and do not abuse the privilege of this access. Non-urgent calls will be returned the next business day.There may be fees associated with these calls.