Home > Adult > Forms

Forms

  • NEW PATIENTS

    All patients seen for the first time will be required to provide us with specific information that will assist us in providing the best and most appropriate care available. You as the patient will need to print and complete the New Patient Paperwork packet and bring this information your initial appointment. Performing this task at home will same you 15-20 minutes of time in the office. A NEW patient cannot be seen until the paperwork is complete.
    PLEASE BRING SHOT RECORD AND LIST OF MEDICATIONS!!

    Patient Profile
    This document will require all the demographics and insurance information regarding the patient. We will need a PHYSICAL address for the patient and the patient will need to provide a picture ID with the same PHYSICAL address. If you want to provide a post office box for correspondence we will be glad to take that information also.

    Records Release TO Doctors Inlet Pediatrics and Primary Care
    Please print and complete this form so we can obtain pertinent medial information from your previous provider. With this form we can obtain medical history regarding illnesses, medications, vitals, and all other necessary information.

    Opioid Informed Consent

    Adult Consent for Release of Medical Treatment & Pharmacy Information
    This form will provide the name and relationship of any person who may obtain information regarding your medical treatment. Also by providing the name of your preferred pharmacy we will be able to call in your prescriptions whenever possible, eliminating wait time at the pharmacy.

    Initial History Questionnaire for ADOLESCENTS and ADULTS
    This form will provide medical information necessary to give us insight into your current and past medical condition.

    HIPAA Privacy Short Notice
    You will need to read and sign the Privacy Notice. This is an abbreviated notice and the Privacy Notice in its entirety is printed and available to read in the front office at check in.