FORMS

 

Form for new patients as well as existing patients to update and provide demographic information, which includes but is not limited to:  insurance information, medical consent, emergency contact information, list of medications, etc. CLICK HERE TO PRINT

This notice describes how we use and protect your personal health information.

This form gives a provider permission to treat your child when he or she is in someone else's care.

Authorize the release of full and complete protected medical information to a requiring entity.

Form to consent to the use or disclosure of protected health information by The Family Physicians, the staff and their business associates for the purpose of diagnosing or providing treatment, obtaining payment for health care bills or to conduct health care operations.

Consent to sign accepting the patient portal terms of use, as well as providing an up-to-date email address.

This form will allow you to designate one or more people of whom you would like us to share your medical information with.

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