Important Note

Make sure to download and save the forms before you fill them out. Once you have completed the necessary forms, please submit via email to info@drsusanmarra.com.

Mandatory New Patient Forms

All new patients are required to complete these forms prior to their first appointment. 

Medical Release Consent Form

Office Guidelines Form

Please arrive on time for your appointment with all paperwork fully completed before coming to the office. This helps ensure fairness to other patients who may be traveling long distances or catching flights, as well as to Dr. Marra. Everyone’s time is valuable, and we appreciate your consideration. Being mindful of the needs of others is a core principle of this office.

Informed Consent Form

Financial Responsibility Form

We require this form to be fully completed and signed by all patients prior to their initial consultation. We greatly appreciate your cooperation, as this is a fee-for-service medical specialty practice.

Arbitration Form

Physician–patient arbitration agreement

HIPPA Consent Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed, and how you can obtain access to this information. Please review this document carefully.

INFORMED CONSENT FOR TELEMEDICINE SERVICES

Telemedicine involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care.

Please download, fill out, and submit forms to: info@drsusanmarra.com. 

If you have any questions, please don’t hesitate to contact us. You can reach our office by phone: (206) 299-2676.