Coming To See Dr. Mikulak

Download, Print, and Complete These Forms Prior To Your First Visit...

1) Patient Information Form

2) Notice of Privacy Practices Receipt

3) Patient Financial Agreement

4) Initial Visit History

Remember to bring the following items:

• X-ray, MRI, EMG or other stuides
• Operative reports
• Diagnostic test results
• Insurance information
• Current list of medications
• Photo identification