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About Us

* Care For The Entire Family

* Emergencies / After Hours

* Contacting Us

* Medication Requests

Our Staff

* Dr. Glenn Withrow

* Anne Vaillancourt, PA-C

* Bruce Bair, PA-C

* Betty Haswell, PA-C

* Podiatry Services - Bruce Fawcett, DPM

Appointments

* Appointment & Walk-in Information

* New Paient Forms

* Establish Patient Forms

* Referral Information

Forms

Administrative Forms

* Adult Health History | Spanish Health History
* Pediatric Health History
* Patient Information Form | Spanish Patient Information Form
* Consent of Treatment Form | Spanish Consent of Treatment Form
* Review of Symptoms

* HIPPA Privacy Practices
* HIPPA Release Form

* Dr. Fawcett Patient Registration Form

* Request for Medical Records to The Family Doctor
* Release of Medical Information from The Family Doctor

* X-Ray Release Form
* Worker's Comp Intake Sheet

Patient Forms

* Blood Pressure Log
* Blood Sugar Log
* BRAT Diet Information
* DASH Diet Information
* Epworth Sleep Scale
* Foreign Travel Shot Info / Prices
* Headache Diary
* Headache Diary Instructions
* Healthcare Power of Attorney
* Living Will
* Medication List
* Pittsburgh Insomnia Scale

Clinical Forms

* Medical Skills Inventory
* Nursing Skills Inventory

* Medical Record Requests / Fees Information

Diabetes Care

Insurance

* Payment Policy

* Participating Insurance Plans

* Worker's Compensation & Company Accounts Information

Employment Opportunities

* Current Position Openings

* PreMedical Internships

Special Services