For Family Medicine Center Patients

Important Forms

If you would like to take the time to complete the applicable forms prior to your initial visit, the forms are available in printer friendly versions below, for your convenience.

English

• Authorization for Release of Confidential Medical Records (English)
  download form
• Authorization for Release of Confidential Medical Records - Minors (English)
  download form
• Medical History (English)
  download form
• Medical Record Release Form
  download form
• Registration Form (English)
  download form
• HIPAA Notice of Privacy Practices (English)
  download form
• Financial Policy (English) 
  download form

Espanol

• Authorization for Release of Confidential Medical Records (Spanish)
  download form
• Authorization for Release of Confidential Medical Records - Minors (Spanish)
  download form
• Medical History (Spanish)
  download form
• Registration Form (Spanish)
  download form
• HIPAA Notice of Privacy Practices (Spanish)
  download form
• Financial Policy (Spanish) 
  download form

Polski

• Registration Form (Polish)
  download form