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Dr.Haley
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Patient Forms

The following forms are provided for your convenience. Please fill out each form completely and submit them to the office one week prior to your appointment.
Forms may be faxed to : 256-327-0891
or mailed/dropped off at our office:

4704 Whitesburg Drive, Suite 201
Huntsville, AL 35802

Choose either "Adult" or "Pediatric" Health History:

Adult Health History

Pediatric Health History

All patients will need the following forms:

Patient Registration

Office Policies

Financial Policy

Notice of Privacy Practices

Receipt of Privacy Notification

Release of Medical Information