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.

To establish care with one of our providers, please complete both the New Patient Request form and the Release of Medical Records form. Follow the return instructions provided in the New Patient Request form for both documents. Completing the Release Form will expedite the transfer of your medical records, allowing your current primary care provider to send your records to our office, should you be accepted into our practice.

Patients who are coming for a Medicare Wellness Exam should complete this form and bring it with them to their appointment.

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.

This option is for healthcare providers, attorneys, or if you are requesting the medical records for someone other than yourself, and are not the legal guardian.

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.

Click on the button below to view all of our ONMM patient forms.