Forms

General Forms

• Member Service Guide
• Member Registration

• New Patient Welcome
• Adolescent / Adult Medical History
• Pediatric Medical History

• Patient Registration & Insurance Assignment
• Financial, Payment & Policies
• Medical Appointment Cancellation

• Advance Health Care Directive
• Authorization for Provider to Release Health Info
• Authorization to Leave Health Information by Alternative Means
• Authorization to Disclose / Release Protected Health Info
• Notice of Privacy Practices

Health Screening Forms

• COVID Health History
• Tetanus & Diphtheria Vaccine
• Influenza Vaccine Consent Form
• Depression
• Generalized Anxiety Disorder
• Mood Disorder
• Osteoporosis Risk
• Personal Diabetes
• Consent for Tuberculin Skin Tests

Specific Services Forms

• IV Drip Therapy
• Massage Therapy
• Vitamin D or B Injections