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)

Your role in your health care

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