Patient Forms

Covid-19 Forms

Name Download File
Consent form – Covid Vaccination- English DOWNLOAD
Consent form – Covid Vaccination- Spanish DOWNLOAD
Moderna Vaccine Information for Patients and Caregivers- English DOWNLOAD
Moderna Vaccine Information for Patients and Caregivers- Spanish DOWNLOAD
Pfizer Vaccine Information for Patients and Caregivers- English: DOWNLOAD
Pfizer Vaccine Information Sheet for Patients and Caregivers- Spanish: DOWNLOAD
How to enroll in V-Safe (text based after-vaccination check-ins from the CDC) DOWNLOAD

General Forms

Below are downloadable forms.  Some are single PDF’s and others are Compressed Zip Files that contain more than one document.

Name Download File
HIPPA (PDF) DOWNLOAD
Release of Medical Information (PDF) DOWNLOAD
Advanced Consent to Treat Minors (PDF) DOWNLOAD
Patient Assistance Plan Application (Zip File) DOWNLOAD
Sports Physical WA (PDF) DOWNLOAD
Sports Physical OR (PDF) DOWNLOAD
New Patient Packet-Minor (Zip file) DOWNLOAD
New Patient Packet-Adult (Zip file) DOWNLOAD
Medicare Annual Wellness (PDF) DOWNLOAD
Notice of Privacy Practices DOWNLOAD
Aviso de Prácticas de Privacidad DOWNLOAD