Patient Forms

In a proactive approach to expediting our registration process, we offer patients the opportunity to preview/print all required registration forms prior to establishing care with our providers. We ask that all patients arrive 15 minutes prior to your scheduled appointment time. Please also bring the following items:

• All forms listed below completed, signed and dated
• Current insurance cards
• Picture ID
• Co-pay (for your convenience we take MC/Visa/Discover/Amex/Bank Debit/Cash/Checks)
• Current list of medications including OTC medications

Patient forms are currently being revised.  Please check back soon!

Mullis Building Location; Dr. Rex Morgan

• NEW – Medicare Wellness Packet
• Patient Information Form Overview
• Patient Medical History Form
• NPP Acknowledgment & Patient Communication Consent Form
• Records Request Release Form
• Patient Privacy Practice Form
• Office Financial Policy Form
• Consent to Contact Form

Park West Location; Dr. Lee Allison

• NEW – Medicare Wellness Packet
• Patient Information Form Overview
• Patient Medical History Form
• NPP Acknowledgment & Patient Communication Consent Form
• Records Request Release Form
• Patient Privacy Practice Form
• Office Financial Policy Form
• Pediatric Medical History Form
  (Must be completed for children 17 and younger.)
• Consent to Contact Form