Forms to complete clinic hero

Forms to complete

Shorten your wait time, fill out these forms

If you cannot fill them out at home, please be sure to arrive early for your appointment.

Patient History

This important form tells the doctor about:

  • Your medical history
  • Your family’s medical history
  • Medications you are taking
  • Allergies
Patient History Form—Adult
– EN
Formulario de historia médica adulto inicial
– ES
Patient history form—Pediatric
– EN
Formulario de historia médica pediátrica inicial
– ES

New patient registration

This short form tells us your:

  • Contact information
  • Insurance information
New patient registration form
– EN
Formulario de inscripción para nuevo paciente
– ES

Once a year: Medicare annual wellness questionnaire

If your insurance is Medicare, you must answer these questions every year. 

This form tells Medicare:

  • Your current doctors
  • Your current health conditions
Medicare annual wellness questionnaire
– EN
Cuestrionario anual de medicare para el bienestar del paciente
– ES

You will also complete two more health screening forms when you arrive. Some patients may have other forms to complete that are required by their health insurance.