Patient forms

Select any of the links below to download important forms for your visit

Click to view the file(s) you need.  (This may be slow to load on some older computers.)
Right-click (PC) or option-click (Mac) to download the form(s).

• Patient Information/Consent To Treat (PDF -- 64k) *
• Adult History Form (PDF -- 72k) *
• Pediatric History Form (PDF -- 96k) *
• Records Release Form to transfer records TO us (PDF -- 136k) *
• Records Release Form to transfer records FROM us to others (PDF -- 136k)
• Authorization Form To Disclose Health Or Billing Information (BLANK) (PDF -- 76k)

* = Highly recommended for new patients.

Our fax:   (704) 384-1181