Adult Yearly Visit Preparation (Non-Medicare) - Adults who do not have a Medicare or Medicare Advantage plan, please complete all components this form at least yearly.

Medicare Annual Wellness Visit Preparation - Adults who do have Medicare or Medicare Advantage, please complete all components of this form at least yearly

New patients please complete both the New Patient Registration form and the New Patient Health Questionnaire.
New Patient Registration 
New Patient Health Questionnaire
Medical Records Request Form - complete this and send to your previous provider(s) to request your records.

Disease Specific Forms - If you have the following conditions, please periodically report the status of your condition back to our practice or when requested by your provider.
Asthma Control Test - How well is your asthma controlled?

Behavioral Health Questionnaires - please use these forms to be screened for various behavioral health conditions when requested by your provider.
Alcohol Questionnaire - Screener for Alcohol use disorder
Buprenorphine Treatment Consent - Consent for our office to treat opiate addiction and expectations of the patient when on buprenorphine.
GAD-7 Questionnaire - Anxiety severity screener
Depression Screening Questionnaire (PHQ-9) -Depression severity screener
Eating Disorder Screening - Screening for Eating disorders
Diet, Exercise, and Weight Perception Questionnaire

Miscellaneous Forms:
Patient Satisfaction Survey
Payment Policy Acknowledgment
Social Determinants of Health - Screening for factors other than physical and mental conditions that will affect someone's health
Change of contact or insurance information
Prescription Refill Request - use this form to request a refill from your provider
Medical Records Request Form - complete this and send to your previous provider(s) to request your records.


Prepare for your Visit with these forms