healthfirst forms

Bring the completed Social History, Patient Info and WebView forms below to your office visit. The Consent for Care and Informed Consent for Telemedicine Services forms will be completed and signatures witnessed in the office.

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Consent for Care

This form is an understanding of our terms and agreement to be seen by our providers with tests and treatments as necessary. This form also includes our HIPPA acknowledgement. THIS FORM IS TO BE COMPLETED AT THE CLINIC.

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Patient Info

This is a two-page form consisting of questions relating to you. Fill out to the best of your knowledge, information found on this form will help us qualify you for assistance with your bills and also build your profile within our system.

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Social History

This is a two page form consisting of questions relating to your social life, and family history on the back side. Please fill out to the best of your knowledge and be truthful as some pertains to your health.

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Informed Consent for Telemedicine Services

This is a two page form agreeing to utilize our telehealth type of appointment, and understanding this is all kept private and is secure. THIS FORM IS TO BE COMPLETED IN THE CLINIC.

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WebView Patient Request Form

This is a two page form. This form needs to include your name, DOB, address, a questions an answer that we can verify with you if you need your password changed in the future. The username will be provided by our office and the password is generic.

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