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Forms

New patient paperwork is typically completed in the clinic at your first appointment, or through MyChart during eCheck-In. Most forms are electronic, so it is not necessary to complete paper forms ahead of time. Use the links below to see the types of information we may request.

Medical records requests can be made with Release of Information forms; completed forms should be submitted to your clinic in person, by mail, or by fax (fax numbers are listed on clinic pages under the Locations tab). You can also view and share medical records in MyChart in the Sharing Hub.

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Notice of Privacy Practices Notificación de Prácticas de Privacidad
Notice of Privacy Practices Signature Form Aviso de Reconcocimiento de Prácticas de Privacidad – formulario de firma
Patient Registration Form Formulario de Registro de Pacientes
Ethnicity, Race & Language Etnia, Raza e Idioma
Financial Release of Information Autorización para Facturar
Adult Medical History Form Antecedentes Médicos de Adultos
Adolescent Medical History Form Antecedentes Médicos de Adolescentes Entre 13 Y 18 Años
Child Medical History Form Antecedentes Médicos del Menor Hasta los 12 Años
Advance Consent to Treat Minor Antención Médica para Menores de Edad
Release of Information – From FCN to another facility/person Solicitud Saliente para Información Médica Protegida (PHI)
Release of Information – To FCN from another facility/person Solicitud Entrante para Información Médica Protegida (PHI)
Financial Policy

Patient Policies

Privacy Practices

Nondiscrimination & Language Assistance