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Patient Forms

Find information and documents needed to become a new patient here

 

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MEDICAL RECORD AUTHORIZATION REQUEST FORMS

Authorization to Release Medical Information for Personal Records/Other Clinics of Facilities:
This form would be used if you require your medical records for personal use or to be given/sent to other clinics or facilities.
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Authorization to Share/Disclose Your Protected Health Information to Family Members or a Personal Representative:
This form would be used if you want to share/disclose your medical records/information to a family member(s) or a personal representative.
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