All forms can be filed via the Charm Patient Portal.
Consent To Treat
Medical History Questionnaire
The questionnaire is designed to help Dr. Frawley learn your general medical history and to save time during your initial visit. This will become part of your medical record. All the information you provide will be strictly confidential. Please fill out the questionnaire online via the email you will be sent when you set up your appointment or bring the completed medical history questionnaire with you to your first scheduled appointment.
Authorization to Disclose Protective Health Information
This authorization must be read, dated and signed by the patient or by a person authorized by law to give authorization on behalf of the patient.
- Release to Discuss Your Information with Others (2 downloads)
- Medical Record Request Form (2 downloads)