Patient Forms

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INDUSTRIAL CLINIC

Patient Information Sheet

Release, Waiver and Financial Responsibility

Patients Rights & Responsibilities

Treatment Authorization

Medical History for Pre-Employment Physical

Medical History for Industrial Injuries

FAMILY CARE

Patient Information Sheet

Release, Waiver and Financial Responsibility

Authorization for Use or Disclosure of Health Information

Patients Rights & Responsibilities

Consent for Medical/Surgical Care/Emergency Treatment and Child's Medical Information

ORTHOPEDICS

Patient Information Sheet

Release, Waiver and Financial Responsibility

Authorization for Use or Disclosure of Health Information

Patients Rights & Responsibilities

PHYSICAL THERAPY

Patient Information for Treatment Appointment

Release, Waiver and Financial Responsibility

Patient Guidelines

Authorization for Use or Disclosure of Health Information

Patients Rights & Responsibilities

MEDICAL RECORDS

Medical Records Release

X-ray Copy Request

Advanced Health Care Directive

Directiva Por Anticipado De La Atencion De La Salud

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