FHMG Patient Info and Consent.pdfPlease print the following eight New Patient forms, fill them out completely and bring them with you to your first appointment.

• NEW Patient Demographic Form

• Patient Information.pdf

• History and Physical.pdf

• Consent For Evaluation or Treatment.pdf

• Written Acknowledgment.pdf

• Attention All Patients.pdf

• Communication Use And Disclosure Authorization.pdf

• Patient Privacy Notice (HIPAA).pdf

Miscellaneous Patient Forms

• Advanced Beneficiary Notice of Noncoverage.pdf
• Authorization to Treat Minors.pdf
• General Waiver for Non-Covered Services.pdf
Authorization for Use and-or Disclosure of Protected Health Information - Pg. 1.pdf Authorization for Use and-or Disclosure of Protected Health Information - Pg. 2.pdf

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