Patient Forms

If you are a new patient please download and complete the following forms. By downloading these forms and completing them, it will save you time when registering for your first appointment. Thank you.

• Patient Registration Form
• Health History Questionnaire
• Advance Care Planning
• Privacy Policy, for you to keep
• Consent to Use and Disclose Protected Health Information
• Patient-Centered Medical Home (PCMH) for you to keep
• Informed consent-for preventative medicine visit (complete physical)
• Depression Risk Screening/Alcohol Risk Screening

Please bring with you at your appointment:

• Your health insurance cards (if you have more than one card, please bring all applicable cards)
• Your driver license
• The forms that you have download and completed

Sincerely,
Tina Wrinkle
Practice Manager
248-625-1600