Patient Information & Forms

New Patient Form

Before your first visit to Daschbach & Associates, please take a moment to download and fill out this form.

CLICK HERE

Health History

Before your first visit, please download and complete this form.  Bring it with you to your appointment.

CLICK HERE

Financial Agreement & Insurance Information

Download this form to read the list of insurance companies Daschbach & Associates works with.

New patients, please fill out this form before your first visit.

CLICK HERE

HIPPA Forms

Please complete and sign both of these forms and bring them to your first appointment.

HIPPA Privacy Form 1

HIPPS Privacy Form 2

Hours

Monday8:30AM – 5:00PM
Tuesday8:30AM – 9:00PM
Wednesday8:30AM – 5:00PM
Thursday8:30AM – 9:00PM
Friday8:30AM – 5:00PM
Saturday8:30AM – 1:30PM
SundayClosed

 

We are located across from the Bergey Car Dealership on Godshall Road.

Call Us

215-721-8811

Fax Us

215-721-5393

Email Us

reception@daschbach.com

Office Location

390 Harleysville Pike, Souderton, PA 18969

I can do all things through Christ who strengthens me
Philippians 4:13