top of page
Okay (45 × 15 in) (15)_edited.png

Secure Digital Forms

The forms below are only provided to you by your doctor if needed. We value your health information, and we want to make sure your security is guaranteed. 
 

12.png

The New Patient Enrollment Form which personal information, contact information, emergency contact and medical history information are provided.

Patient Telehealth Consent Form

5.png

A telehealth consent form is used to gather informed consent from patients agreeing to telehealth services for diagnosis or treatment.

Patient Payment Authorization Form

4.png

With a payment authorization form, you can collect authorization for payment from your customers before making a payment.

Access Form

Okay (45 × 15 in) (34)_edited.jpg

This form is used by patients to register clinical history by providing their personal and contact information, weight, drug allergies, illnesses, operations, healthy habits, etc.

Patient Consent to Release of Information Form

8.png

This form allows a patient to give authorization to 3rd party and access their health records. A medical release form can be revoked at any time by the patient.

Patient Insurance Form

6.png

Patient Insurance Form is used to confirm that a patient has the necessary insurance coverage for any services they receive. 

GAD-7 Outcome Measures

10.png

The Generalized Anxiety Disorder Assessment (GAD-7) is a seven-item instrument that is used to measure or assess the severity of generalized anxiety disorder.

PHQ-9 Form

Okay (45 × 15 in) (23).png

The Patient Health Questionnaire (PHQ-9) is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.

Medical History Form

11.png

A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations.

Medical Consent for Minor Form

Okay (45 × 15 in) (24).png

A medical consent form for minors is used to get consent from parents or guardians before a child receives medical treatment. 

Disability Accommodation Request Form

Okay (45 × 15 in) (16).png

Disability Accommodation Request Form is a document created and used to gather data concerning request that patients may have for reasonable accommodations.

HIPAA Authorization Form

Okay (45 × 15 in) (33).png

This Patient Medical History Form template is used by patients to register clinical history through providing their personal and contact information.

bottom of page