What's New
- Valentine's Day is around the corner
- GBPSA on YouTube
- Complimentary Cosmetic Consultations
- New Season - Good Reason to invest in yourself
- WHY Choose GBPSA?
Read more
Forms and Documents
- Adult Demographic Form
Please print and complete if you are an ADULT seeing the physician and bring it with you to your appointment.
- Minor Demographic Form
Please print and complete if the patient seeing the physician is a MINOR, bring it with you to your appointment.
- Patient Health History Form
Please print and complete, bring with you to your appointment.
- Auto Insurance Information Form
Please print and fill out if the patient was involved in a motor vehicle accident and will be seeing our physician for related injuries.
- Medical Record Release To Us
Please fill out for medical information to be released to GBPSA from another physician's office.
- Medical Record Release From Us
Please fill out for medical information to be released from GBPSA to another physician's office.
- Medical Record Future Release
Please complete this form for patient records for future appointments (i.e. 3-month follow-up, 6-month follow-up, or 1-year follow-up) and the proper medical record release form as well.
- Liability Insurance Form
Please print and fill out if the patient was involved in an accident and there is a third party responsible (i.e. Homeowner's or Auto Insurance).
- Worker's Compensation Form
Please print and bring to your employer and have them fill out form completely and send back to us.