Patient Forms

On this page you can find some of our paperwork when becoming a new patient. If you need any help please contact us.

New patients are given a packet containing a welcome letter, patient responsibilities pamphlet, application, patient data sheet, HIPAA privacy form and a sliding fee application. If assistance is needed to complete the packet, a member of our staff would be glad to help. Our patient service representatives will have you complete a release of records to request records from former providers and specialist.

Patient Data Form

Sliding Fee Form

Sliding Fee Policy Form

Farmworker Verification Form

Privacy Practices Form

HIPAA Notice of Privacy Practices

RMS HIPPA Form

For more information, please contact us