Patient Forms

For the convenience of our patients we provide the forms listed below. Please note that patient registration is done electronically in our office at time of your visit

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com.

• Notice of Privacy Practices - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
• Authorization for Release of Medical Information - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
• Authorization and Consent for Treatment - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
• Preferred Contacts - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
• Financial Policy - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
• Language Services
• Blood Glucose log sheet