Patient Forms Forms for new patients, financial assistance, privacy practices, and medical records are available to download in English and Spanish. Forms in English Forms in Spanish Forms in English Registration New Patient Forms for Adults - English New Patient Forms for Children - English Financial Assistance Financial Assistance Program Requirements (English & Spanish) Statement of Self-Employment Income (English) Statement of Support (English) Wage Verification (English and Spanish) Privacy Notice of Privacy Practices (English) Medical Records Request to Inspect Form (English) Request Amendment to PHI Form (English) Confidential Communications Request Form (English) Restriction Request Form (English) HIPAA Privacy Complaint Form (English) Authorization to Disclose PHI Form (English) Request for an Account of Disclosures Form (English) Medical Attention After Hours Medical Attention — Evenings & Weekends (English & Spanish) Forms in Spanish Registration New Patient Forms for Adults - Spanish New Patient Forms for Children - Spanish Financial Assistance Financial Assistance Program Requirements (English & Spanish) Statement of Self-Employment Income (Spanish) Statement of Support (Spanish) Wage Verification (English and Spanish) Privacy Notice of Privacy Practices (Spanish) Medical Records Request to Inspect Form (Spanish) Request Amendment to PHI Form (Spanish) Confidential Communications Request Form (Spanish) Restriction Request Form (Spanish) HIPAA Privacy Complaint Form (Spanish) Authorization to Disclose PHI Form (Spanish) Request for an Account of Disclosures Form (Spanish) Medical Attention After Hours Medical Attention — Evenings and Weekends (English & Spanish)
