Click the green link above to access the New Patient Forms.  Please complete all four pages of the questionnaire.  The first page contains instructions and other information for your upcoming appointment as well as a place to write in the date and time.  

You have several options for completing the questionnaire:

1. Print out the questionnaire and complete by hand.  Then bring it with you to your appointment.

2. Fill out the questionnaire online and then print it out and bring it to your appointment.  You will be required to sign the questionnaire.

3. Fill out the questionnaire online and email the document to:

•     info@drasseff.com

If you choose to submit your questionnaire by email, please note the following:

• Dr. Asseff's email system is HIPAA compliant, but your personal email system may not be HIPAA secure.  If you are concerned about HIPAA privacy, do not email the form.  
• Put your name and appointment date on the subject line of the email.
• We will ask you to sign the questionnaire at your appointment.

 Although our privacy notice is posted on this website, you may also print out a copy for yourself here.  Click the green link above to access the HIPAA notice.

Click the green link above to access the HIPAA acknowledgment.  Please complete, print, and sign the form and bring it with you to your appointment.  If you do not bring this form to your appointment, we will ask you to sign one at the office.  We have copies of our HIPAA notice available at the office for you to review.