Dr. Dullye Office Forms (Dr. Fogwell's forms are listed below those for Dr. Dullye):

New-Patient Information Form for Dr. Dullye Patients

We will need information about you during your first visit.  This information comes from a new-patient information form you will complete online (or optionally fax or mail to our office) and a separate medical history questionnaire you will complete online.  To access the new-patient information form, click the link below, then follow the instructions.  This is the fastest way to get started.  However, if you would rather have us mail you the form, contact our office.  But please remember that the completed form MUST be returned to us before we can schedule your first appointment.

Please note: When you schedule a new-patient appointment with Dr. Dullye, you will be asked for your credit card or debit card information, as our office has a 24-hour cancellation policy.  If you fail to show up for your appointment, or cancel your appointment within the 24-hour timeframe, the credit card or debit card you provide us will be charged a $40.00 same-day cancellation fee.  Our office will not be liable for any associated overdraft fees placed by your bank.  To speed the scheduling process, please have your credit or debit card information available when you schedule a new-patient appointment with our office.

Also, due to the nature of our practice, occasionally there are delays during appointments.  We apologize in advance for any inconvenience this may cause you.  As a new patient, we ask that you allow at least one hour and 30 minutes for your appointment.

Click this link to bring up the Patient Information Form on your screen. 

Medical Records Release Form for Dr. Dullye Patients

Complete this Medical Records Release Form only if you are asked to do so by Dr. Dullye's office.   If you prefer to receive the form by mail, please call our office and let us know.   Once you have completed all the information on the form, please fax or mail it to our office.

Click this link to bring up the Medical Records Release Form on your screen. 

On-line Medical History Questionnaire for Dr. Dullye Patients

All patients must complete this On-line Medical History Questionnaire -- an integral part of our electronic medical records system -- one time.  The Internet link for the questionnaire is https://patients.digichart.com.  Since the questionnaire and its completion are part of our highly secure electronic medical records system, we will contact you with your personal log-on and other important information when we call to schedule your appointment.

Footsteps Childbirth Education Class Registration Form

If you plan to attend the Footsteps "Pregnancy to Birth" childbirth education class, please complete this registration form.

For information about the class, click here.

Click this link to bring up the Footsteps class registration form.

******************************************************************************************************

Dr. Fogwell Office Forms (Dr. Dullye's forms are listed above):

New-Patient Information Forms for Dr. Fogwell Patients

We will need information about you during your first visit.  This information comes from forms you will complete and then fax or mail to Dr. Fogwell's office.  To access the forms, click the link below, then follow the instructions.  This is the fastest way to get started.  However, if you would rather have us mail you the forms, contact our office.  But please remember that the completed form MUST be returned to us before we can schedule your first appointment.

Click this link to bring up the Patient Information Forms and information on your screen. 

Last modified: April 01, 2011