FORMS

If you would like to become a patient of Heritage Family Medicine we ask that you please call our offices and speak to our staff. Please have insurance information on hand to provide to the staff. Thank You.

MEDICAL RELEASE FORM

 

A medical release form allows your information to be given to other healthcare professionals. This speeds up the process of medical history and allows our providers to send your medical records over to other physicians.

NEW PATIENT PACKET

 

This New Patient Packet has everything you need before you come in for a visit. It includes information to help you get to know our office, HIPAA release form, new patient information form, medical history from, and a minor release form. (Only patients under 18 years of age need to fill out the minor release form.)

HIPAA NOTICE OF PRIVACY PRACTICES

 

HIPAA Notice of Privacy Practices state our privacy practices and the disclosure of medical information. Our practice is dedicated to maintaining the privacy of your individually identifiable health information. We are required by law to maintain confidentiality of health information that identifies you.

OFFICE INFORMATION HANDOUT

 

There are times that our office may have changes to the way we handle things such as new tests, procedures, referrals, labs and changes of insurance and phramacies. To keep you updated with the changes, here is our office information handout so you can be familiar with new policies and procedures in our office.

HOW ARE WE DOING?

 

We would love to hear how your visit went with Heritage Family Medicine & Aesthetics. If you could please fill out this questionnaire, this will help us understand how we can better serve our patients. Thank you.

PATIENT TESTIMONIAL

 

We’d love to hear about your experience at Heritage Family Medicine & Aesthetics. If you would like to give your testimonial over the treatment or service you received, please fill free to do so by filling out this form. Thank you.