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