Forms

Forms

For your convenience, you may find it is easier to complete these forms at home where you have access to your medical records. By completing your paperwork in advance, you can minimize the wait time on the day of your appointment.

Forms to complete

Print these forms, fill them out, and bring them with you to your first appointment. If any of your personal or insurance information changes, please complete a new Patient Registration Form and bring it to your next visit.

• Patient Registration Form
• Medical History Sheet
• Financial Responsibility Agreement
• Loan Agreement and Promissory Note
• Medical Records Release Form - Use this form to request medical records to be sent to or from your CarePlus doctor.
• HIPAA Privacy Notice Form – This completed form documents receipt of our notice of Privacy Practices.
• Notice of Privacy Practices –This notice describes how your medical information may be used and disclosed, and how you can get access to this information.