Patient Forms
Want to make your next office visit a little easier?
You can either access our ELECTRONIC FORMS and fill them out electronically or
print out our PDF FORMS and bring them with you on your next visit.
PATIENT FORMS
Registration Forms:
Individual Forms:
Supplemental/Optional Forms:
- Patient Portal Opt-Out Form
- Medical Records Release Form*
(If you would like your previous records sent to EMG, please complete this form and submit prior to your appointment.) - SCC Urgent Medical Records Release Form (For senior patients only)
PATIENT FORMS (ENGLISH)
Registration Forms:
Individual Forms:
- General Health History Questionnaire
- Consent to Use and Disclosure of Health Information Form
- Financial Policy and Agreement Form
- Change of Information Form
Supplemental/Optional Forms:
- Patient Portal Opt-Out Form
- Medical Records Release Form*
(If you would like your previous records sent to EMG, please complete this form and submit prior to your appointment.) - SCC Urgent Medical Records Release Form (For senior patients only)
- Benzodiazepine Agreement
- Notice of Privacy Practices
- Member Rights & Responsibilities
- Advance Directive
FORMULARIOS DE PACIENTES (ESPAÑOL)
Formularios de Registro:
Formularios Individuales:
- Cuestionario de historial general de salud (Visita inicial) (General Health History Questionnaire)
- Consentimiento del paciente para el uso y la divulgación de información médica para el tratamiento, el pago o las operaciones de atención médica (Consent to Use and Disclosure of Health Information Form)
- Política y acuerdos financieros del paciente (Financial Policy and Agreement Form)
- Actualización de datos (Change of Information Form)
Formularios Opcionales:
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