Patient Forms

Please complete these forms and bring them to your first appointment. You may email (uppervalleyendo@gmail.com) or fax (802-296-2012) your forms to us in advance.

• Notice of Privacy Practices (Keep for your records)

• Acknowledgement of Receipt of Privacy Practices

• Authorization and Consent (Complete only if you selected "Unencrypted Email" on above form)

• Patient Information

• Billing and Insurance Information

• Medication List