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)
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
