Forms

Forms: English

Patient Registration Information

Patient Consent

Medical Information Release

Consent of Medical Treatment for Minors

Adult Past Medical History

Patient Portal Consent

Cell Phone Policy

Medical Record Request From Another Facility

Medical Record Release To Another Facility

Immunization Registry Consent – Adult

Immunization Registry Consent – Minor

Forms: 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

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• Testimonials

  "Youens & Duchicela Clinic's staff is the reason I use them as my primary care giver. From the kindness they show to the knowledge they possess, its always a positive experience each time I go to the clinic for treatment."
  
  - James