Our Services
Aesthetics
Our aesthetic services help you look your best. We offer chemical peels, microdermabrasion, dermal fillers,
Read MoreFamily Practice
Our family nurse practitioners provide care for the whole family. Available services include management of
Read MoreObstetrics and Gynecology
We provide high-quality OB/GYN care to women at all stages of life, from puberty through menopause.
Read MoreAesthetics
Our aesthetic services help you look your best. We offer chemical peels, microdermabrasion, dermal fillers,
Read MoreFamily Practice
Our family nurse practitioners provide care for the whole family. Available services include management of
Read MoreObstetrics and Gynecology
We provide high-quality OB/GYN care to women at all stages of life, from puberty through menopause.
Read MoreNew Patients
Before your first appointment, please fill out the paperwork below. Provide as much detail as possible to ensure
we have a complete picture of your health history and are aware of any concerns that could affect your care.
Intake History
To make appropriate health recommendations, we need some information about your past medical history and current use of medications. Please fill out this form with as much detail as possible to ensure we have the information needed to develop a comprehensive treatment plan.
To make appropriate health recommendations, we need some information about your past medical history and current use of medications. Please fill out this form with as much detail as possible to ensure we have the information needed to develop a comprehensive treatment plan.
Use and Disclosure of Personal Health
This form discusses our privacy practices and authorizes us to share certain information for treatment and/or billing purposes.
This form discusses our privacy practices and authorizes us to share certain information for treatment and/or billing purposes.
Patient Authorization Record
The Patient Authorization Record indicates that we have your permission to treat you and bill you for the services we provide. It also contains details about billing and assignment of benefits.
The Patient Authorization Record indicates that we have your permission to treat you and bill you for the services we provide. It also contains details about billing and assignment of benefits.
Patient Registration Form
It's important that we have your current contact information and insurance details on file. Please provide your name, address, telephone number, and billing information on this form.
It's important that we have your current contact information and insurance details on file. Please provide your name, address, telephone number, and billing information on this form.
Payment and Collection Policy
Summit Medical's Payment and Collection Policy summarizes our financial policies and provides details about our payment plans to obstetrical and surgical patients.
Summit Medical's Payment and Collection Policy summarizes our financial policies and provides details about our payment plans to obstetrical and surgical patients.
Patient Portal
Summit Medical offers a patient portal to help patients
take control of their health care. With our patient portal,
it's easy to update your contact information,
communicate directly with care providers, review
detailed summaries of your health records, and access
the results of recent lab tests. You can even review your
medication list and keep track of your allergies