The following forms and corresponding instructions have been provided for your convenience. Please note that these forms may not be the appropriate forms for all patients in all circumstances.
Coronavirus (COVID-19) Information
New Patient Forms
New patients can save time during their first appointment by completing the Patient Registration form prior to their visit. Simply print out the Patient Registration form, fill in the information requested, and bring the completed form with you to your appointment.
Use this form to send copies of documents to your clinic. This may include insurance cards, test results from other healthcare providers, etc.
Formas en Español
Debe usted completar el registro del paciente antes de su primer cita. Necesita usted impremir el registro del paciente, completarlo, y traerlo a su cita.
Wellness and Routine Exam Forms
Patients seeking a routine preventive exam (annual physical) should read the Routine Preventive Exam document below before their appointment.
Medical Records Request
To have medical records released, please complete the Authorization to Disclose Protected Health Information form and mail to PO Box 191050, Boise, ID 83719, ATTN: Medical Records. You can also fax the completed form to (208) 985-1425, ATTN: Medical Records. Questions regarding the release of medical information can be addressed to Medical Records Coordinator, at (208) 955-6498 or email@example.com.
Immunization records can be printed directly from the Patient Portal.
Submit Medical Records
Patients may email their own medical records to us at firstname.lastname@example.org. Please note that using this website to email your records is not secure.
Confused about what immunizations your health plan covers? This helpful checklist will guide you through the conversation with your health plan before your next visit if it may include immunizations.
- Affidavit of Personal Representative
- Narcotics Contract
- Carequality Opt-Out
- End of Life Planning Toolkit
- Protected Health Information Release
- ADHD Parent Assessment
- ADHD Teacher Assessment
- ADHD Parent and Teacher Assessment Follow-Up
- 7th - 8th Grade Physical Form
- High School Physical Form
- Notice of Injury
- Preparing for Your DOT Physical
- DOT Physical Form
- Occupational Health Registration Form
- OSHA Respirator Questionnaire
- Treatment Referral Form*
Formas de Occupational Health en Español
*Employers, please use the Treatment Referral Form when sending your employees into our clinics for drug and alcohol testing. Using this form increases our ability to perform the correct services for you and your employees. If you would like a custom form made specifically for your company’s needs, please contact the Occupational Health department.
Contact us today to learn more.