The following downloadable forms are available in PDF format for your convenience. We encourage you to print them off, complete them at your leisure in the privacy of your home, and bring them with you to your appointment. Please be assured that no information is being transmitted over the Internet; you are merely printing a blank form.
- Family Patient Registration Form
- Patient Registration Form (18 years or older)
- Use or Disclosure Permission Form
- Release of Records Form
- Authorization to Treat Form
- Payment Consent Form
- Letter to School-Day Care
- HIPAA Notice of Privacy Practices
- HIPAA Acknowledgement and Consent Form
The following forms* are available through our Patient Portal only:
- A Preschool/Daycare Form
- A School Blue Form
- Boys Scout Health Form
- Brewster School Form
- Pop Warner Form
- School Sports Participation Form
- WIC Form
- Camp Form/Generic
*If needed within 48 hours (2 business days or less M-F), the cost of the form will be $10.
Spring and summer are our busiest times; please give us sufficient time to complete your form.
EFFECTIVE June 13, 2016:
Payment MUST be received before any form is dropped off or completed by our forms department.