Patient Forms

To expedite your appointment check in process, please read over the provided Patient Forms listed below prior to your appointment. Please print the “Signature Form”, fill out and sign, and bring the day of your appointment. You may also print out the Medication List form and fill out prior to your appointment.

HIPPA and FINANCIAL RESPONSIBILITY Form

HIPPA and FINANCIAL RESPONSIBILITY Form (Spanish)

Informed Consent to Telemedicine Form

Informed Consent to Telemedicine Form (Spanish)

Standard Authorization, Former Medical Records Authorization, and Cancellation Policy Form

Standard Authorization, Former Medical Records Authorization, and Cancellation Policy Form (Spanish)

Advance Beneficiary and Pathology Lab Form

Advance Beneficiary and Pathology Lab Form (Spanish)

Signature Form (Spanish)

Medication List Form

Medication List Form (Spanish)