Patient Forms
For Your Health
Prescription Refills
Online refill system...
Before your visit...
Helpful Links...
Joni Stasiak MD
Steve Stasiak MD
Care for the entire family...
New Patient Intake Forms
Our HIPPA Policy
DOT Driver Physical Form
Medical exam form for truck drivers.
Sports Physical Form
Medical exam form for participation in high school athletics.
Family Medical Leave-
A general Family Medical Leave Act form.
Reserved for future use!
We may need to add more!
Forms and other “paperwork”...
We may direct you to this site prior to your visit to download one or more of the following forms. You can complete to “paperwork” at your own pace prior to your visit with us. Click on the form below to open it at the bottom of this page for viewing or printing.
Forms to complete prior to coming in for your first visit.
Our full health information privacy policy for you to read at your convenience.
