Forms & Policies - Community Family Practice

Folder Forms & Patient Policies

NOTE: You must have Adobe Acrobat Reader installed to view and print these forms. It is a free download from Adobe.com.

Categories

Folder Well Child Checks

Includes questionnaires for developmental stages of your child's growth. The M-Chat should be included for 18 months and 2 year well-child visits.

pdf 1. New Patient Packet

Download this packet or forms and fill out before your first visit!

pdf Adult Physical Exams

We will print a copy of your information at subsequent wellness visits for you to easily make changes. Thank you for completing this one by hand.

pdf Appointment Policy

pdf Billing Policies for Annual Exams

pdf Consent for Telehealth Services

pdf Divorce/Marital Discord Policy

pdf Incoming Records Release Form

pdf Medicare Annual Wellness Visits

pdf Notice of Privacy Practices

This notice describes how medical information about you may be used or disclosed and how you may get access to information

pdf Obtaining your Lab Results

pdf Outgoing Records Release Form

pdf Outside Lab Policy

pdf Patient Portal Consent Form

Required consent form to participate in the online patient portal.

pdf Payment Policy

Answers questions regarding patient and insurance responsibility for services rendered