Forms

After scheduling a visit with your Partnership Health Center, you may be asked to fill out a form(s) to bring with you to your appointment. Our staff will inform you of which form(s) you will need.

 

Below you can find these forms. If asked, please download, print out, fill-in, and bring the requested forms to your appointment. If you have any questions about which form(s) is needed, please call your Partnership Health Center.

**Please note that all new patients must complete the New Patient History, Patient Information, and Consent for Treatment forms.

General Forms

New Patient History 

Patient Information

Consent for Treatment

Medical Records Release

Tele-therapy Policy and Consent

Vaccination Forms

COVID Vaccine

Consent - J&J

COVID-19 Lab Requisition Form

COVID-19 Testing Consent Form

Vaccine Information Statement

Flu Screening Checklist