Patient Forms

Listed below are the links for the new patient forms that we request you fill out and bring to your first appointment. If you prefer to fax these forms, you may send to 843-842-9963 or scan and email them to our office e-mail address info@hickeycenter.com. However, please have hard copies available in case we do not receive them.

• Authorization to Release
• Authorization for Disclosure of Health Information
• Authorization to Obtain Information
• Medical History Form
• Medicare Opt Out Form (Mandatory for Medicare Patients. This form is only for Medicare Patients.)
• New Client Registration