{"id":995,"date":"2022-11-15T00:05:11","date_gmt":"2022-11-15T00:05:11","guid":{"rendered":"http:\/\/wpsite.dr-polcino.com\/?page_id=995"},"modified":"2022-11-15T10:59:22","modified_gmt":"2022-11-15T10:59:22","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/wpsite.dr-polcino.com\/?page_id=995","title":{"rendered":"Patient Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"995\" class=\"elementor elementor-995\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d44fbcc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d44fbcc\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6f547de\" data-id=\"6f547de\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-23a7978 elementor-widget elementor-widget-text-editor\" data-id=\"23a7978\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.7.6 - 15-09-2022 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#818a91;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#818a91;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>Click on the links below for the document you wish fill out. You can fill out online and print, or print and then fill out by hand. Please bring with you or fax it back to us before your visit at <strong>(631) 321-1102<\/strong>.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-801b860 elementor-widget elementor-widget-heading\" data-id=\"801b860\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.7.6 - 15-09-2022 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h4 class=\"elementor-heading-title elementor-size-default\">New Patients\/Last visit over a year ago\n<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-00e4431 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"00e4431\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-53ef923\" data-id=\"53ef923\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c81a795 elementor-button-info elementor-align-justify elementor-widget elementor-widget-button\" data-id=\"c81a795\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a href=\"http:\/\/wpsite.dr-polcino.com\/wp-content\/uploads\/2022\/11\/Dr_Polcino_Patient_Intake_Form.pdf\" class=\"elementor-button-link elementor-button elementor-size-sm elementor-animation-push\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Patient Intake Form<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-bf5266f\" data-id=\"bf5266f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1b090df elementor-button-info elementor-align-justify elementor-widget elementor-widget-button\" data-id=\"1b090df\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a href=\"http:\/\/wpsite.dr-polcino.com\/wp-content\/uploads\/2022\/11\/Dr_Polcino_HIPAA_Authorization_Form.pdf\" class=\"elementor-button-link elementor-button elementor-size-sm elementor-animation-push\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">HIPAA Authorization<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-06bb458\" data-id=\"06bb458\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8099c41 elementor-button-info elementor-align-justify elementor-widget elementor-widget-button\" data-id=\"8099c41\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a href=\"http:\/\/wpsite.dr-polcino.com\/wp-content\/uploads\/2022\/11\/Dr_Polcino_Notice_of_Privacy_Practice_Form.pdf\" class=\"elementor-button-link elementor-button elementor-size-sm elementor-animation-push\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Notice of Privacy Practices<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0446a04 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0446a04\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-39b11ae\" data-id=\"39b11ae\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b66636e elementor-widget elementor-widget-heading\" data-id=\"b66636e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">New Obstetrical patients<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-abea092 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"abea092\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-ca297b7\" data-id=\"ca297b7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-22d11c8 elementor-button-info elementor-align-justify elementor-widget elementor-widget-button\" data-id=\"22d11c8\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a href=\"http:\/\/wpsite.dr-polcino.com\/wp-content\/uploads\/2022\/11\/Dr_Polcino_Obstetrical_Medical_History.pdf\" class=\"elementor-button-link elementor-button elementor-size-sm elementor-animation-push\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Obstetrical Medical History<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-8f7486c\" data-id=\"8f7486c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3c60392 elementor-button-info elementor-align-justify elementor-widget elementor-widget-button\" data-id=\"3c60392\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a href=\"http:\/\/wpsite.dr-polcino.com\/wp-content\/uploads\/2022\/11\/Dr_Polcino_Obstetrical_Instructions.pdf\" class=\"elementor-button-link elementor-button elementor-size-sm elementor-animation-push\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Obstetrical Instructions<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-41e99be\" data-id=\"41e99be\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-99dc63c elementor-button-info elementor-align-justify elementor-widget elementor-widget-button\" data-id=\"99dc63c\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a href=\"http:\/\/wpsite.dr-polcino.com\/wp-content\/uploads\/2022\/11\/Dr_Polcino_Diet_Instructions.pdf\" class=\"elementor-button-link elementor-button elementor-size-sm elementor-animation-push\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Diet Information<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-3b6cd0b 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data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a href=\"http:\/\/wpsite.dr-polcino.com\/?page_id=896\" class=\"elementor-button-link elementor-button elementor-size-lg elementor-animation-push\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Information Center<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Click on the links below for the document you wish fill out. You can fill out online and print, or print and then fill out by&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/wpsite.dr-polcino.com\/index.php?rest_route=\/wp\/v2\/pages\/995"}],"collection":[{"href":"https:\/\/wpsite.dr-polcino.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wpsite.dr-polcino.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wpsite.dr-polcino.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wpsite.dr-polcino.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=995"}],"version-history":[{"count":19,"href":"https:\/\/wpsite.dr-polcino.com\/index.php?rest_route=\/wp\/v2\/pages\/995\/revisions"}],"predecessor-version":[{"id":1057,"href":"https:\/\/wpsite.dr-polcino.com\/index.php?rest_route=\/wp\/v2\/pages\/995\/revisions\/1057"}],"wp:attachment":[{"href":"https:\/\/wpsite.dr-polcino.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=995"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}