PATIENTS

Patient Forms

These forms are provided for your convenience. To help us serve you as quickly as possible, please download, print, and complete any required/requested forms in advance of your visit.

FORM DESCRIPTIONDOWNLOAD LINK
Patient Registration Form – EnglishDownload Form
Patient Registration Form – SpanishDownload Form
HIPAA Privacy Policy – EnglishDownload Form
HIPAA Privacy Policy – SpanishDownload Form
Attestation FormDownload Form
Consent for Treatment of MinorDownload Form
No Show Policies and Procedures – EnglishDownload Form
No Show Policies and Procedures – SpanishDownload Form
Medical Records ReleaseDownload Form
GBMS Sliding Scale Payment Application – EnglishDownload Form
Patient Eligibility Screening RecordDownload Form
Consent to Obtain External Prescription History – EnglishDownload Form
Consent to Obtain External Prescription History – SpanishDownload Form
FORM DESCRIPTIONDOWNLOAD LINK
Patient Registration
Form – English
Download Form
Patient Registration
Form – Spanish
Download Form
HIPAA Privacy
Policy – English
Download Form
HIPAA Privacy
Policy – Spanish
Download Form
Attestation
Form
Download Form
Consent for
Treatment of
Minor
Download Form
No Show
Policies and
Procedures –
English
Download Form
No Show
Policies and
Procedures –
Spanish
Download Form
Medical Records
Release
Download Form
GBMS Sliding
Scale Payment
Application –
English
Download Form
Patient Eligibility
Screening Record
Download Form
Consent to
Obtain External
Prescription
History – English
Download Form
Consent to
Obtain External
Prescription
History – Spanish
Download Form

New Patient?

You can create an account and schedule your first appointment here.

Existing Patient

If you are an existing patient, simply click below to login to your account.

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Affordable Healthcare — With or Without Insurance

We are happy to serve you whether you have commercial insurance, Medicaid, Medicare, or are uninsured. We will work out a sliding scale payment that is based on your income.

Below are SOME of the many insurances, Medicaid, and Medicare plans we accept.