Patient Information & Forms

Additional Patient Information & Forms

Please download, print, and complete the following Adobe Acrobat PDF form:

Request for Confidential Comm Form

Use this form to authorize Family Wellness Center providers to communicate your protected health information to another person or facility.


New Patient Registration & Financial Policy form

All new patients must complete this form to set up an individual account with Family Wellness Center. Bring completed form along with your insurance card with you to your first appointment.


Annual Physical form 

For annual physicals, complete this form and bring it with you to your appointment.


Children & Teens Under Age 18 form
A parent of a NEW pediatric patient should complete this form and bring it to their child’s first appointment at Family Wellness Center.


Medical Records Release TO Family Wellness Center
If you are requesting that your records come TO Family Wellness Center.

 


What are Preventative Care Visits, Problem Based Visits and Secondary Services?

The difference between a preventative care visit, a problem based visit and having a secondary service at a preventative care visit.

What’s Happening

01/08/18 Family Wellness Center to Join Legacy Medical Group in April of 2018

Family Wellness Center to Join Legacy Medical Group in April of 2018 after 23

12/21/17 Clinic Closures on Monday, December 25, 2017 and Monday, January 1, 2018

The clinic will be closed on Monday, December 25, 2017 and Monday, January 1,

12/21/17 Tuberculosis Testing Recommended for Wy’east Middle School.

Tuberculosis testing for 187 students and staff members at Wy’east Middle Sc