Patient Forms

Forms for all patients (except for those coming in only for a flu shot):

Financial Agreement

Patient Registration Form

Patients coming in for a Flu Shot should complete the following:

Influenza Vaccine Consent Form

Also, please read this Influenza Information Sheet

In order to treat an unaccompanied minor (under the age of 18), the following form must be filled out:

Authorization to Treat a Minor

In order to release Health Care information, the following form must be filled out:

Authorization to Release Health Care Information