{"id":88,"date":"2018-08-21T15:59:15","date_gmt":"2018-08-21T21:59:15","guid":{"rendered":"https:\/\/fueldev.site\/~swient\/?page_id=88"},"modified":"2024-04-22T16:59:13","modified_gmt":"2024-04-22T22:59:13","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/www.swient.com\/our-practice\/resources\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2024\/04\/swient_financial_policy_form_interactive-1.pdf\" rel=\"noopener\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>Financial Policy<\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2024\/03\/swient_notice_of_privacy_practices_v12.pdf\" rel=\"noopener noreferrer\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>Privacy Practices <\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2024\/04\/swient_patient_info_v16-1-1.pdf\" rel=\"noopener\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>Patient Demographics<\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2024\/03\/swient_patient_communication_authorization_v7-1.pdf\" rel=\"noopener noreferrer\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>Patient Communication Authorization<\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2023\/05\/swient_adult_health_history_form_fillable-1.pdf\" rel=\"noopener noreferrer\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>New Adult Health History <\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2023\/05\/swient_child_health_history_form_fillable-1.pdf\" rel=\"noopener noreferrer\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>New Child Health History <\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2024\/02\/swient_authorization_release_medical_records_fillable-1-1.pdf\" rel=\"noopener noreferrer\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>Authorization to Release Medical Records <\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2023\/05\/swient_dizziness_questionaire_v6-1.pdf\" rel=\"noopener noreferrer\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>Dizziness Questionnaire <\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2023\/05\/swient_desmond_fall_risk_questionaire_v5-1.pdf\" rel=\"noopener noreferrer\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>Desmond Fall Risk Questionnaire <\/strong><\/div>\n<div class=\"post-op-box\"><a class=\"form-link button no-form-blurb\" download=\"\" target=\"_blank\" href=\"https:\/\/www.swient.com\/wp-content\/uploads\/2024\/04\/swient_vng_instructions_interactive-1.pdf\" rel=\"noopener noreferrer\"><svg aria-hidden=\"true\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 384 512\"><path fill=\"currentColor\" d=\"M360 480H24c-13.3 0-24-10.7-24-24v-24c0-13.3 10.7-24 24-24h336c13.3 0 24 10.7 24 24v24c0 13.3-10.7 24-24 24zM128 56v136H40.3c-17.8 0-26.7 21.5-14.1 34.1l152.2 152.2c7.5 7.5 19.8 7.5 27.3 0l152.2-152.2c12.6-12.6 3.7-34.1-14.1-34.1H256V56c0-13.3-10.7-24-24-24h-80c-13.3 0-24 10.7-24 24z\"><\/path><\/svg><\/a><i class=\"form-link button-icon fa fa-file-pdf-o\" aria-hidden=\"true\"><\/i><strong>ENG\/VNG Instructions<\/strong><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Financial Policy Privacy Practices Patient Demographics Patient Communication Authorization New Adult Health History New Child Health History Authorization to Release Medical Records Dizziness Questionnaire Desmond Fall Risk Questionnaire ENG\/VNG Instructions<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1498,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","schema":"","fname":"","lname":"","position":"","credentials":"","placeID":"","no_match":false,"name":"","company":"","review":"","address":"","city":"","state":"","zip":"","lat":"","lng":"","phone1":"","phone2":"","fax":"","mon1":"","mon2":"","tue1":"","tue2":"","wed1":"","wed2":"","thu1":"","thu2":"","fri1":"","fri2":"","sat1":"","sat2":"","sun1":"","sun2":"","hours-note":"","locid":"","rating":""},"service_tags":[],"_links":{"self":[{"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/pages\/88"}],"collection":[{"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/comments?post=88"}],"version-history":[{"count":27,"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/pages\/88\/revisions"}],"predecessor-version":[{"id":2559,"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/pages\/88\/revisions\/2559"}],"up":[{"embeddable":true,"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/pages\/1498"}],"wp:attachment":[{"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/media?parent=88"}],"wp:term":[{"taxonomy":"service_tags","embeddable":true,"href":"https:\/\/www.swient.com\/wp-json\/wp\/v2\/service_tags?post=88"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}