Information required from our new patients.
Medications, allergies, past/current medical issues, hospitalization and surgical history, family and immunization history are all factors to consider.
Allows patients to give permission for their health information to be shared with a specific person, firm, organization, or facility.
This form informs patients that they are solely responsible for all medical services they receive, regardless of insurance eligibility or coverage determinations.
This form includes our no show and cancellation policy and requires an agreement signature from all patients.
Female specific review of systems and symptom checklist.
Male specific review of systems and symptom checklist.
Allows patients to give permission for their medication history to be obtained through a patients pharmacy, health plans, and other health care providers.
Describes how health information about you (as a Care Center patient) may be used and disclosed, as well as how you can obtain access to your personally identifiable health information. Please read this message thoroughly.
Allows patients to give permission for their health information to be shared with a specific person, firm, organization, or facility.
This packet covers your rights and our duties to you, as well as your options for what information we can share with you and how we normally use and share your data.
