Patient Forms

Please fill out all applicable forms and bring with you to your first appointment.

New Patient Information Form

• Adult female
• Adult male
• Child/adolescent

Medical Records Release Form (use page 1 to have your records sent TO MAHEC; use page 2 to have your records sent to another practice)

HIPAA Notices of Privacy Practices

Patient Bill of Rights

If you'd like a copy of the MEND telemedicine forms that you will sign electronically before your first telemedicine visit, please click here.