Patient Information / Forms – ICS By Fustok

Patient Information for Consultation

For your convenience you will find the necessary forms below for you to download and fill out prior to your appointment which will expedite the waiting process. Please complete and review these materials carefully. You will need to provide the completed forms along with your driver’s license or ID card and insurance card on the day of your scheduled consultation. Please arrive 15 minutes prior to your scheduled appointment to ensure that all paper work was properly filled out. Doing so will help minimize your wait time and provide you more time with the Doctor.

Click on the links below to download the necessary forms:

Patient Information
New Patient Forms (Female)
New Patient Forms (Male)

Medical Release Form

To have your records released to us or to another Doctor please complete the medical release form and then you should send a signed copy to the medical office that will be releasing your records to us.

Medical Release Form

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