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Printable Documents

patient formsMedical Patient Forms:

Patient Registration - pdf
General demographic and insurance information.

Communications Preferences - pdf
Tell us how how to contact you.

HIPAA Privacy Form - pdf
This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Medical History Questionnaire (Adult) - pdf
Medical History Questionnaire (Birth to 4 years old) - pdf
Medical History Questionnaire (5 to 17 years old) - pdf
Share your medical history with your provider team.  Please note these forms are age specific.

Financial Policy - pdf
Know what to expect regarding paying for your care.

Release of Information - pdf
Permit us to receive medical records from previous or other providers, if applicable.

Release of Information for Restricted Conditions - pdf
Permit us to receive drug and alcohol treatment information, if applicable.

Parental Consent Form - pdf
Indicate your preference regarding who may bring your child for medical care and whether we may see your older child without you present.

Diabetes Care Patient History:

Diabetes Care Center New Patient - pdf