Patient Forms

Below are several forms that can be printed and filled out prior to your appointment.  Each is in PDF format for ease of opening and printing.

Patient Forms

• Consent for Telemedicine Services
• Health History Form (new patients only)
• Patient Registration Form
• Privacy Permissions Form
• Medicare Welcome to Medicare/Annual Wellness Visit Form (existing patients only)
• Appointment Cancellation Form

Release of Information

• Release of Information Form

Privacy Policy

• Patient Notice of Privacy Practices
• Privacy Practice Agreement

Accountable Care Organization Notification

• Aledade ACO Patient Notification Letter  (Medicare patients only)

No Surprises Act Notification

• No Surprises Act