healthfirst forms

Bring the completed Patient Info, Social History and Supplies by Mail (optional) forms to your appointment. The Consent for Care form 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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HIPAA Notice of Privacy Practices

This two page document describes how medical information about you may be used and disclosed and how you can get access to this information.  Please review carefully and call or stop in to one of our clinic locations if you have questions.

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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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Supplies by Mail Consent

This form allows you to have your method of birth control automatically sent to you.

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