Patient Forms
Please download and print these forms to make your visit as quick and efficient as possible.
Once they are completed, bring them with you to your appointment. If you have any questions regarding the paperwork, please feel free to contact the location you will be visiting. You can access your location’s contact information by visiting our Locations page.
Please do not email these forms to your provider or the location you intend to visit. Email communication is not secure, and your protected health information (PHI) may be intercepted or compromised by people other than the intended recipient.
New Patient Registration
Medical History
Patient Consent Agreements and Financial Policies
Privacy Practices Acknowledgement
Authorization for Use or Disclosure of PHI
- AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION
- AUTHORIZATION FOR USE OR DISCLOSURE OF REPRODUCTIVE HEALTH
- AUTORIZACIÓN PARA EL USO O LA DIVULGACIÓN DE INFORMACIÓN DE SALUD
- SOLICITUD DE USO O DIVULGACIÓN DE INFORMACIÓN MÉDICA PROTEGIDA RELACIONADA CON LA ATENCIÓN MÉDICA REPRODUCTIVA
- DAIM NTAWV TSO CAI SIV LOS SIS MUAB KOJ TEJ NTAUB NTAWV KHO MOB TAWM
- SIV LOSSIS KEV QHIA TAWM NTAWM COV NTAUB NTAWV KEV NOJ QAB HAUS HUV UAS MUAJ KEV TIV THAIV (PHI) TXOG KEV SAIB XYUAS KEV YUG MENYUAM