Forms & Information

New Patient - Adult

Notice of Health Information Practices (review prior to appointment)
Adult Registration (used at your first appointment)
Adult Health History (used at your first appointment)
MyChart Access Agreement (used to establish online access to your health information via MyChart - page 1 only)
Authorization for Disclosure of Health Information (used to transfer medical records from an outside facility) - Effective Nov.2011- ask your clinic for this form, it is not available online

New Patient - Pediatric

Notice of Health Information Practices (review prior to appointment)
Pediatric Registration (used at your child's first appointment)
MyChart Access Agreement (used to establish online access to your health information via MyChart - pages 1 and 2)
Authorization for Disclosure of Health Information (used to transfer your child's medical records from an outside facility)

Established Patient Forms

Family Information Sheet
Healthcare Directive (used for clearly documenting your decisions about your health care - also called a Living Will)
Permission to Treat a Minor (used when a minor will be coming in for specific treatment without a parent/guardian present)
Power of Attorney (used for clearly documenting your decisions about your health care)

Additional Information