This form includes personal information about you, insurance information, and gives us authorization to treat you and to bill and accept assignment for payment from your insurance company(s). Please download this form, complete and sign, and bring with you to your first visit.
This form is used to give your authorization to SUDHA KARUPAIAH MD PC to release your medical records to another physician and/or organization, or to obtain your medical records from another physician and/or organization.
This form provides an overview of your medical history and family medical history to the physician and is instrumental in providing your physician with the information necessary for him/her to begin your patient/physician relationship. Please complete this form as detailed as possible, and bring it with you to your first visit.
This document describes how medical information about you may be used and disclosed, and how you can get access to this information.
By signing this form, you are giving permission to your doctor to access your prescription history
This sleep questionnaire provides useful information for patients seeking help with sleep disorders. If you are scheduled for a sleep consultation, please print and bring this completed form with you for your first visit.
Download this form to apply for the Disabled Person Placard or Plate, and mail it to the Department of Motor Vehicles address is shown on the form.
A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or you have stopped breathing.
This form allows you to designate someone to make health care decisions for you when you are unable.