Patient Forms
Patient Forms
We are also happy to offer you the option to download, print and complete our office forms to reduce wait times during your first appointment.
We are also happy to offer you the option to download, print and complete our office forms to reduce wait times during your first appointment.
- Authorization to Release Health Information
(For Transfers Out, Transfers In, Copy for Self and Coordination of Care with family or schools) - Authorization for to Release Medical Information to Family Members
(For patients 18 years old or older to share information with family members)
- Authorization to Release Sensitive Health Informaiton
(For sensitive information like HIV/AIDS, Genetic Information, Alcohol and/or Drug Abuse or Sexually Transmitted Diseases)
- Authorization to Release Psychotherapy Notes
(For requesting integrated behavioral health notes from NAP)
- Family History Form
- Patient Registration Form for Children under 18 years old
- Patient Registration Form for Patients over 18 years old
- HIPAA Notice of Privacy Practices
- Nondiscrimination and Accessibility Requirements Notice
- Area Adult PCP List
- Tips for Choosing an Adult PCP
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
Patient Forms
Please view our full site to save and print out a copy of your patient forms.
Please view our full site to save and print out a copy of your patient forms.
