Forms and Documents

We’ve put together this online library of important forms and other documents in multiple languages to make it easier for you to get the information you. Here you’ll find everything from new patient packets to our privacy notice to your Patient Bill of Rights, Authorization and Telehealth consent forms, and dentistry applications.

Read-only PDF/Word Docs (click to download):

Medical Visit Planner

Patient Visit Planner

New Patient Packet

New Patient Packet-ENGLISH

New Patient Check-Off List-ENGLISH

New-Patient-Packet-Mosaic-Health-update-08-14-192-ARABIC

New-Patient-Packet-Mosaic-Health-update-08-14-192-NEPALI

New-Patient-Packet-Mosaic-Health-update-08-14-192-SPANISH

New-Patient-Packet-Mosaic-Health-update-08-14-192-KAREN

New-Patient-Packet-Mosaic-Health-update-08-14-192-BURMESE

Patient Authroization for Treatment

Patient Authroization for Treatment ENGLISH

Patient Authorization for Treatment_BURMESE

Patient Authorization for Treatment_KAREN

Patient Authroization for Treatment ARABIC

Patient Authroization-for Treatment NEPALI

Patient Authroization for Treatment-SPANISH

Health Care Proxy

Health Care Proxy-CHINESE

Health Care Proxy-RUSSIAN

Spanish Health Care Proxy-SPANISH

Health Care Proxy-ENGLISH

Controlled Substance Patient Acknowledgment

Controlled Substance Patient Acknowledgment-ENGLISH

Controlled Substance Patient Acknowledgment-NEPALI

Controlled Substance Patient Acknowledgment-ARABIC

Controlled Substance Patient Acknowledgment-BURMESE

Controlled Substance Patient Acknowledgment-KAREN

Controlled Substance Patient Acknowledgment-SPANISH

HIV Testing

HIV Testing – Public Health Law

HIV Testing Form – Russian

HIV Testing Form- English

HIV Testing Form – Spanish

Patient Authorization to Release Health Information

Permission to Release Patient Information – ENGLISH

Permission to Release Patient Information – SPANISH

Permission to Release Patient Information – ARABIC

Permission to Release Patient Information – BURMESE

Permission to Release Patient Information – KAREN

Permission to Release Patient Information – NEPALI

Patient Authorization to Obtain Health Information

Permission to Obtain Patient Information – ENGLISH

Permission to Obtain Patient Information – SPANISH

Permission to Obtain Patient Information – ARABIC

Permission to Obtain Patient Information – BURMESE

Permission to Obtain Patient Information – KAREN

Permission to Obtain Patient Information – NEPALI

Patient Authorization to Share Health Information

Permission to Share Patient Information_KAREN

Permission to Share Patient Information-ENGLISH

Permission to Share Patient Information_BURMESE

Permission to Share Patient Information-SPANISH

Permission to Share Patient Information-ARABIC

Permission to Share Patient Information-NEPALI

Patient Privacy

Patient Privacy Notice_ENGLISH

Patient Privacy Notice-KAREN

Patient Privacy Notice_ARABIC

Patient Privacy Notice_NEPALI

Patient Privacy Notice-BURMESE

Patient Privacy Notice-SPANISH

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