Patient Forms

Patient Forms 2018-04-17T17:14:59+00:00

For your convenience

Save time by downloading new patient forms from this website. Please fill out the forms below in advance of your first appointment to decrease your time in the waiting room. Make sure you bring the completed forms as well as your insurance card with you.

  • Patient Registration  In order to complete this form you will need information about your employer, insurance company, and contact numbers in case of emergency.
  • Personal Health Information  The more information you can provide the easier it will be to serve you to the best of our abilities, so you will be asked to fill out a patient history form when you arrive for the first time.
  • Billing Procedures This form gives you information about our billing policies and, when signed, authorizes us to have your insurance benefits paid directly to Grants Pass Podiatry.
  • Consent to Use or Disclose Medical Information   This form tells us whom we have your permission to call with information about your health and provides a brief statement about your patient rights.
  • Privacy Policy  We encourage you to read and understand our Notice of Privacy Practices. Please ask any questions you may have about this at your first appointment.