Patient Forms and Policies

For the convenience of our patients, here are copies of commonly used forms. All forms and instructions are also provided in the office during appointments. Please call 814-480-8220 if you have any questions or concerns. Dr. Bergqvist and his caring staff are ready to help you.

Please print and fill out the following forms prior to your initial consultation with Dr. Bergqvist.

Health Disclosure
Medical History
Medical Condition History
Patient Information
Treatment Authorization