Patient forms

Intake Forms

Everything Dr. Gildin needs before and during your visit, in one place.

Before you startComplete forms after Dr. Gildin has reviewed your injury by text. Forms are submitted securely through FormDr. Don’t email or text forms.

Form 01

General Consent for Medical Evaluation and Treatment

Contact details, medical history, medications, allergies, payment responsibility and consent to be evaluated.

Open form

QR code that opens the form: General Consent for Medical Evaluation and Treatment — **Scan to open**Same secure form.

Form 02

Informed Consent for Suturing

Consent for the repair itself: anesthesia, tetanus status, risks, alternatives and follow-up care.

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QR code that opens the form: Informed Consent for Suturing — **Scan to open**Same secure form.

Form 03 · Optional

Consent for Use of Ambient AI Clinical Documentation

Optional. Allows an AI assistant to help Dr. Gildin write your visit notes.

Open form

QR code that opens the form: Consent for Use of Ambient AI Clinical Documentation — **Scan to open**Same secure form.

Payment

Pay your reservation fee or invoice

Card, Zelle or Venmo, with links and QR codes on the payment page.

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