Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.
"An excellent physician! I spent time working as a nurse for Dr. Seeley on two different occasions and I can honestly say it was a pleasure to work with him. I respected him and admired his dedication to his patients. He is a kind & caring physician with a wide range of talents in the field of medicine."
"I was tired of my previous primary care physician treating me like a number so I found Dr. Seeley. After one visit I knew he was my new doctor. A compassionate, caring, professional and down to earth human being. All rare commodities in today's day and age. An unashamed Christian man with a heart for people in pain. I was amazed with him and so happy he has made Springfield his new home. My wife and I actually enjoyed a visit to a doctors office, it was more like visiting a an old friend rather than being processed through a health care factory. If you're looking for a new PCP or need a second opinion this Doctor is thorough and compassionate!"
"Dr Seeley takes time to get to know each patients needs. I have been going to him for about 40 years and love him. In times of difficulty he has always been able to find out what I need or have done. Great doctor! "
Patient Forms
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Office Policies
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)
Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)