We have provided medical forms we use in our health care clinic, and recommend you download and complete pertinent forms prior to your office visit. This ensures the most accurate patient information and speeds up the check-in process.

Notice of Privacy Policy

Please print and read this form so you are aware of our privacy policies. You do not have to bring in the form to your office visit. The purpose of this form is to inform you of how your medical information may be used and disclosed, and how you can obtain access to this information.

Notice of Privacy Practices (NPP) Policy and Financial Policy

Please print and read this form. You will need to answer question #10, sign, date, and bring it with you to your first office visit.

Authorization for Release of Confidential Medical Records

This form allows you to request your medical records from another provider so that they can be sent to our office in preparation for your visit. This will allow our providers to review all of your pertinent medical records. Please print this form and take it to your other Doctor or Specialist prior to your office visit.

Coordination of Benefits Form

Blue Cross Blue Shield Coordination of Benefits form. This form is to be filled out in the event there is another insurance policy in addition to BCBS to determine primary and secondary policy coverage.

Notice of Health Information Practices (English)
Notice of Health Information Practices (Spanish)


The above medical forms are downloadable in PDF files. You will need Adobe Acrobat reader in order to view them. If you do not have this program, click here to get a free copy of the software.