The following patient forms are available for access and download.
Notice of Privacy Practices (PDF) – View/Download
Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Authorization for Release of Medical Information (PDF) – View/Download
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Authorization and Consent for Treatment (PDF) – View/Download
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Preferred Contacts (PDF) – View/Download
Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
Financial Policy (PDF) – View/Download
This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Language Services – View/Download
