Patient Forms

You may print the following forms from our website and bring them with you to your appointment or we can supply you copies at the time of service.

Collaborative Health Partners has partnered with Sharecare to fulfill your requests for records. We are committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices. If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.

All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.

Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

This policy describes the process for the documentation,maintenance, and transmission of information using virtual visit technology.

Click on the button below to view all of our Pediatric patient forms. These include the new patient packet, safety and risk questionnaire and the ages and stages questionnaire.