Forms for your Visit with Dr. Jon Lebsack

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Below, you'll find several of our forms. Please print and complete the forms, and bring them to your appointment.


Health History

Please use this form to let us know about your health history. Knowing about your health is an important part of making sure you get the best care possible.


Our Privacy Policy

We respect the privacy of our patients, and this form explains our privacy practices and policies in detail. We ask that you please read it carefully, and sign it, as an acknowledgement that you understand and accept it.

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