Forms and Information

• Notice of Health Information Practices

You can open and print any of the following forms to complete and return to your clinic in person or by fax or mail:

• Pediatric Registration (used at your child's first appointment)
• Medical History (used at first appointment)
• Authorization for Disclosure of Health Information (used to release your records to or from another office)
• Permission To Treat an Unaccompanied Minor (used when a child under age 18 goes to the doctor without parent or guardian)
• Permission to Treat a Minor when Accompanied by Non-Parent or Guardian (used to designate an adult other than the parent or guardian to give consent to medical or surgical treatment by any licensed physician or hospital)
• MyChart Access Agreement (used to establish online access to your health information via MyChart)

Your role in your health care

• Patient Rights and Responsibilities
• 10 Tips for Better Health Care