Forms

Patient Forms: English

Patient Registration Information

Patient Consent

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

Formularios de Pacientes: Español

Informacion de Registro de Paciente

Consentimiento para el Tratamiento Medico

El Portal de Paciente

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

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.

• Testimonials

  "I'm afraid I can't be brief - there are too many good things to talk about. Our doctors are superb - at the top of the list. They are educated, knowledgeable and trained in all facets of Family Medicine. These doctors have built a clinic that is well-equipped to treat all illnesses... Those who provide services - from the front desk ladies, to the nurses, lab technicians and of course the doctors are all kind, thoughtful and friendly. It is a professional relationship but you feel a genuine, heartwarming concern for one's health in a facility that sparkles with cleanliness. I would not go anywhere else for my medical care - and haven't for 16 years."
  
  - Patricia