PATIENT FORMS

FAX COVER SHEET please add this cover page to your fax when you send your medical records and your picture ID into our office. Fill the form in and fax it along with your attached documents to our office at 1-866-350-8090.

MEDICAL RECORD RELEASE form that you may use to get your records released from your doctor, clinic or hospital, etc. and have them fax the records to our office for your file. Fill the form in and give or fax to the medical facility and have them fax to our office at 1-866-350-8090 or mail to the office location of the form.

PATIENT PHYSICAL EXAM FORM form that you can take to your physician and have filled out with information about your existing condition.

	Free Downloads
	Documents	Size
	pcs_agreement.doc Agreement to Utilize On-line Pharmacy Form	26KB	Agreement to Utilize On-line Pharmacy Form
	in_person_phys_exam_agree.doc In Person Physician Exam/Assessment Service Agreement	27KB	In Person Physician Exam/Assessment Service Agreement
	patient.doc Patient Fax Cover Sheet	57KB	Patient Fax Cover Sheet
	authorization.doc Authorization for Release of Patient Medical Information	37KB	Authorization for Release of Patient Medical Information
	physical.doc Physical Exam Form for Patients	31KB	Physical Exam Form for Patients