Forms
Patient Forms: English
- Patient Registration Information
- Patient Consent
- Notice of Privacy Practices
- Medical Information Release
- Consent of Medical Treatment for Minors
- Adult Past Medical History
- Patient Portal Consent
- Telemedicine Consent
- Augmedix Consent
- Cell Phone Policy
- 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
Video Chat: Helpful Documents
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.
