What's New

New forms available on-line

Posted on: 07/09/2010

We have added several new forms to our on-line forms section. You can access these forms by going to the “For Parents” section and clicking on “Patient Forms.”

Patient Responsibility Agreement
Our Patient Responsibility Agreement explains our policies and your role as part of the family and practice contract. This form will be required annually for each child. Please read, print, sign and present this form upon check-in to make this process more efficient.

Adolescent Questionnaire and Adolescent Confidentially and Consent
Our Adolescent Questionnaire and Adolescent Confidentially and Consent are for patients age 12 years through 20 years. The Adolescent Questionnaire can be printed and completed prior to the annual well visit to help make the visit time more efficient. Parents should sign the Adolescent Confidentially and Consent for teens age 12 through 17 years. Our providers will review these questions as part of quality care for your adolescent regardless of the consent being signed. The consent assures your trust and confidentiality between the adolescent and the provider. Patients ages 18 through 20 years do not need the Adolescent Confidentially and Consent signed by the parent.

Below is some additional information about adolescent confidentiality and staying in touch with your teen. Also attached is a note about Chlamydia/GC, a recommended and important screening test for sexually active patients.

Click here for : A note to parents about adolescent confidentiality and staying in touch with your teen.

Over 18 HIPAA Release and Consent
Patients age 18 years and older will be required to complete our Over 18 HIPAA Release and Consent. This form will give the level of consent authorized for release of medical information. Our staff will need this consent to speak with anyone other than the patient for medical care and advice.

For Asthma Patients
The Asthma Control Test 4 to 11 years and Asthma Control Test 12 years and older are forms that can be printed and completed by our asthma patients. We use this control test to evaluate our asthma patients at the annual well visit and asthma re-check visits.