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PATIENT FORMS

New Patient Packet

This collection of forms will be filled out when seeking treatment at EOPA.

Please click on your provider's name to download their corresponding form packet.

Dr. Rochmans' Patient Forms

If Dr. Todd Rochman is your provider, you can find the forms you need below.

Notice of Privacy Practices EOPA

This notice describes how medical information about you may be used, disclosed and safeguarded, and how you can get access to this information.

Access to Telemedicine

Please fill out this form for consent to use telehealth services.

You can also download our instruction sheet by clicking here for using the Doxy.me service.