Dear Patient,

In order to maximize the time that we have to spend with you during your visit, we encourage you to print the following health forms at home, fill them out, and mail them to:

Dr. Jonathan D. Hall
92 Montvale Ave, Suite 3300
Stoneham, MA 02180

You can also fax the forms back to our secure office fax at 781-279-2368

You may also attach a list of your medications. We also ask you to fill out the Patient Record of Disclosures to let us know how you would like to be contacted from our office.

This will allow us to have this placed into your electronic medical record by the time of your visit.

The Patient Bill of Rights does not have to be returned to us, but you will be asked to document that you have received and read this at the time of your office visit.

Don’t hesitate to call if you have any questions at 781-279-7930.

Looking forward to seeing you soon!

Dr. Hall & Staff

Patient Health Forms:

• Medical History
• Financial Information
• Record of Disclosure
• Patient Bill of Rights
• Patient Acknowledgement of Receipt of Privacy Practices Consent & Release Form
• Patient Acknowledgement of Receipt of Privacy Practices Consent & Release Form(Spanish)
• Notice of Privacy Practices
• Notice of Privacy Practices (Spanish)

*Must be on a computer

Consult Cancellation Policy

Dr Hall charges a fee for his cosmetic consultation that helps to defray the cost of seeing you in the office. The time to see you is reserved. The fee is charged by credit card at the time of booking your appointment. We understand that plans may change and this is fully refundable if canceled 5 or more business days before.