Forms
Patient Forms: English
Patient Registration Information
Consent of Medical Treatment for Minors
Medical Record Request From Another Facility
Medical Record Release To Another Facility
Immunization Registry Consent – Adult
Immunization Registry Consent – Minor
Dr. Olga Duchicela’s Health Risk Assessment
Dr. Jorge Duchicela and Mrs. Adamson’s Health Risk Assessment
Medicare Shared Savings Program, Our ACO
Formularios de Pacientes: Español
Informacion de Registro de Paciente
Consentimiento para el Tratamiento Medico
Consentimiento para Tratamiento Medico de Menores de Edad
Uso de Teléfonos Celulares y Dispositivos Móviles
Video Chat: Helpful Documents
How To Use Our Video Chat To See Your Physician
Troubleshooting Guide For Your Smartphone
Employment Application
All forms above are in Adobe PDF format, and require Acrobat Reader. If you do not have Acrobat Reader, you may download it for free by clicking below.
