Patient Forms

If you prefer to mail your completed forms to us in advance of your appointment, please mail them
to the office where you will be seen.  You can find a list of locations and mailing addresses by clicking here.

 

 

NEW ADULT FEMALE PATIENT 

1.) AGES 18-64: Click  HERE  to download the forms you will need to print out, complete, and bring with you to your first visit.

2.) OVER AGE 65: Click HERE to download the forms you will need to print out, complete, and bring with you to your first visit. 

3.) Click HERE to read our privacy policy, patient bill of rights, and patient centered medical home brochure (you do not need to print these unless you want a copy for your records).

 

 

 

NEW ADULT MALE PATIENT (AGE 18 AND OVER)

1.) Click  HERE  to download the forms you will need to print out, complete, and bring with you to your first visit. 

2.) Click HERE to read our privacy policy, patient bill of rights, and patient centered medical home brochure (you do not need to print these unless you want a copy for your records).

 

 

NEW PEDIATRIC PATIENT (NEWBORN TO AGE 17)

1.) Click  HERE  to download the forms you will need to print out, complete, and bring with you to your first visit. 

2.) Click HERE to read our privacy policy, patient bill of rights, and patient centered medical home brochure (you do not need to print these unless you want a copy for your records).

 

 

COMPLETE PHYSICAL FOR ADULT PATIENT (OVER AGE 18)

1.) Click  HERE  to download the forms you will need to print out, complete, and bring with you to your visit. 

2.) Click HERE to read our privacy policy, patient bill of rights, and patient centered medical home brochure (you do not need to print these unless you want a copy for your records).

 

 

ESTABLISHED PEDIATRIC PATIENT (NEWBORN TO AGE 17)

All paperwork will be given at check-in when you arrive for your appointment.
 

 

 

NEW SPORTS MEDICINE PATIENT

1.) Click  HERE  to download the forms you will need to print out, complete, and bring with you to your first visit. 

3.) Click HERE to read our privacy policy, patient bill of rights, and patient centered medical home brochure (you do not need to print these unless you want a copy for your records).

 

 

ANNUAL WELLNESS VISIT

1.) Click  HERE  to download the form you will need to print out, complete, and bring with you to your visit. 

3.) Click HERE to read our privacy policy, patient bill of rights, and patient centered medical home brochure (you do not need to print these unless you want a copy for your records).

 

 

MEDICAL RECORDS RELEASE FORMS

1.) Click  HERE  to download our medical records release forms in English. Use page 1 to have your records SENT to another facility; use page 2 to request that MAHEC RECEIVE your records from another office.

2.) Click HERE to download our medical records release forms in Spanish.  Use page 1 to have your records SENT to another facility; use page 2 to request that MAHEC RECEIVE your records from another office.

Note that a fee will be charged if you are requesting the records for yourself.  There is no charge for sending records to another facility.

 

 

MEND TELEMEDICINE CONSENT FORMS

You will sign these forms electronically at the beginning of your telemedicine visit.  If you would like a copy for your records, please click  HERE.