Downloadable Forms
For your convenience, we have posted a number of commonly used forms that you may be asked to complete when you visit one of our offices.
These forms are available in PDF format, and are available for you to download, print and complete prior to your visit. You can drop forms off in office or send them by email. By completing forms ahead of time, you can minimize the amount of time you spend at our office. Release forms are required for our office to transfer out records to a new provider.
Authorization to Release Health Information- To release medical records for transfer of care to another doctor's office or for personal use.
Permission to Release Medical Information 18 Years and Up -To allow a party (usually a parent or guardian) to have access to an adult patient's records.
Privacy Notice- How Protected Health Information is used and disclosed.
Authorization for the Treatment of Minors -To authorize an individual (usually relative or family friend) to be involved in treatment of a patient under 18 years old.
Financial Policy- Financial policy including missed appointment fee, co-pay agreement, and self-pay policy updated May 2024.
Other common forms can be found here.
Forward your forms to your child's primary office at:
sycamoreforms@gmail.com
masonforms1@gmail.com
lebanonforms@gmail.com
