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Primary Care
Forms & Information
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)
Pediatric Health History
(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)
Pediatric Intake
Authorization for Disclosure of Health Information
(used to transfer your child's medical records from an outside facility)
Developmental Screenings
Developmental Screening
(Please print and complete prior to your 18 month and 24 month well child check and bring to clinic on day of visit.)
Established Patient Forms
Family Information Sheet
Advanced Directive
(used for clearly documenting your decisions about your health care - including a Living Will)
Permission to Treat an Unaccompanied Minor
(used when a minor will be coming in for specific treatment without a parent/guardian present)
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)
Additional Information
Patient Rights and Responsibilities
10 Tips for Better Healthcare
Medication Safety