Forms

All new patients will be asked to complete the following forms at their first visit:

New Patient Packet

For annual preventative services patients should bring the following forms to their visit:

Preventative Care Form  (for all patients)

Annual Female Exam  (for female patients only)

History and Physical Form (for male patients)

Annual Wellness Visit Packet

South Hilyard Clinic Office Policies:

Privacy Policy

Financial Policy Acknowledgement

Use of Social Sercurity Numbers Policy & Procedure

Grievance Policy and Procedure

Cancellation and Appointment Policy

Emailing Protected Health Information

Service Animal Policy

Miscellaneous

Patient Intake Form

Release of Medical Records

Emailing Protected Health Information (PHI) Waiver

Pulmonary Function Testing Instructions

Lead Screening Form

MCHAT

Commercial Driver Medical Certification Report Form (MCSA 5875)

Nondiscrimination Statement