Alert: Phone Scam Warning. Learn More

Patient Forms

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Please verify the cancellation policy with your Provider’s office. Cancellation policy is subject to change without notice and may vary by Provider and/or location.

New Adult Patient Forms

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New Pediatric Patient Forms

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NPP Patient Acknowledgement

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Patient No-show, Cancellation and Re-scheduling Policy

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PHI Release Authorization

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Privacy Policy

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Update Adult Patient Information Form

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Alert: Phone Scam Warning

We’re seeing an increase in phone scams targeting patients. Callers may pose as Medicare, your doctor’s office, or another healthcare provider to obtain your Medicare number or other personal information.

Please remember:

  • Never share your Medicare number, Social Security number, or banking information with unsolicited callers.
  • Medicare will never call you unexpectedly to request your number or personal details.
  • Be wary of offers for “free” medical equipment or services in exchange for your Medicare information.
  • If a call seems suspicious, hang up and contact the clinic where you receive care directly using the phone number listed on our website for that location.

To report a suspicious call: Call 1-800-MEDICARE (1-800-633-4227) or visit reportfraud.ftc.gov.

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