Instructions

You may print off each form (as needed) and then fill it out and bring it in with you at your next appointment

Patient Forms

• Patient Registration and Consent Form
• Authorization to Share PHI
• Informed Consent for Telemedicine Services
• Notice of Privacy Practices (April 2017)
• Financial and Clinic Policy

Additional Documents

• Medical Records Release Form (Nov 2017)
• Medical History Questionnaire (Oct 2019)

Note: Forms will open in a new window