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.

In the event of a medical emergency, call 911 or go to the nearest hospital emergency room.

• Patient Data Form
• Sliding Fee Form
• Sliding Fee Policy Form
• Farmworker Verification Form
• Privacy Practices Form
• HIPAA Notice of Privacy Practices
• RMS HIPPA Form