New Patient Forms
Print forms, complete and bring with you to your first appointment
Page 8 is for females 40 and older only. Page 9 is for males 40 and older only.
Agenda Setting Tool
Established patients and new patients:
Complete and bring with you to your appointment

Authorization to Treat a Minor

Records Release
To have records sent TO Dr. Jones-Poland
Records Release
To have records sent FROM Dr. Jones-Poland to someone else

Note: Fees may be incurred when requesting records from our office.
Medical Marijuana Policy