Patient Forms

Patient Forms

Forms which may be needed for visits to the health department:

English:

HIPAA Policy -English

Notice of Privacy Practices – English

Client Demographic Information – English

Health History Form – English

Financial Policy – English

Financial Declaration – English

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Español :

HIPAA Policy – Spanish

Notice of Privacy Practices – Spanish

Client Demographic Information – Spanish

Health History Form – Spanish

Financial Policy – Spanish

Financial Declaration – Spanish

Last Updated on September 4, 2019