Office Forms

Below you can access some of our office forms.  You can print these forms fill them out and bring them to your next appointment.  These forms include...

• New Patient Registration / Existing Patient Demographic Update
• Patient Health Information form (for use by our providers) pages 1 & 2
• Request for Release of Your Medical Records to Premier Family Medicine
• Financial Policy
• Summary Notice of our Privacy Practices
• Acknowledgement of Receipt of Financial Policy, of Summary Notice of Privacy Practices, and Laboratory Results Reporting Policy (included on form) 

To Print the following forms...

• Click on a picture to open it (you may need to right-click, select "open picture")
• Right-click on opened picture, select "Print Picture"

Registration & Demographic Update

Patient Health History

Transfer PHI to Premier Family Medicine

Financial Policy

Summary of Privacy Practices

HIPAA Release

IHSAA Physical Form