Forms

Required For ALL Appointments:

Consent to Treat Form

Consent for Telemedicine

No Show Fee

Patient Registration Form

Service Related Forms:

General Health History Questionnaire

Well Woman Exam Questionnaire

Medical Records Release Form

Parental Consent for Minors

Caregiver's Authorization Affidavit

Part I: TB Risk Assessment and Testing Form

Part II: TB Screening Questionnaire Form

ISP Minor Consent Form

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