Patient Forms - Your Family Medical Clinic

Patient Forms

Primary Care

New Patient Registration Packet – This packet contains all the forms below and everything we need to register you as a new patient
HIPAA & Consent – Consent to treat you and our HIPAA policy
Medical Records Release – If you need to release medical records to us from another facility
Cancellation Policy – Our policy with regard to canceling an appointment
Medication List – List of all of the medications you are currently taking

Mental Health

Adolescent PHQ 9 – Assess the Degree of Depression Self-Assessment
Adult PHQ 9 – Assess the Degree of Depression Self-Assessment
Generalized Anxiety Disorder GAD7 – Anxiety Self-Assessment
Beck’s Depression – Depression Self-Assessment
Adult ADD/ADHD – ADD/ADHD Self-Assessment

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