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Primary Care Clinic Forms

If you are a new patient, please complete the following New Patient Forms Packet. Please print all forms single-sided.

Download The New Patient Forms Packet

If you need to complete or update individual forms, please print each form single-sided and bring them to your next appointment.

Individual Forms

Parental Consent for Treatment (Minor presenting alone or with an authorized non-parent/guardian)

Communication of Personal Medical Information

HIPAA Release of Medical Information

Financial Policies

Joint Notice of Privacy

New Patient Medical Questionnaire

Stimulant Medication Agreement

Provider-Patient Agreement for Long-Term Controlled Medications

Medicare Annual Wellness Forms

The following forms should be filled out only by patients who are on Medicare. They should be completed before every annual Medicare Wellness Visit or if there are any changes between visits.

Fall Risk Assessment

Medicare Secondary Payer Questionnaire

Medicare Wellness Packet

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