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

10/03/17 How to Save the Life of a Gunshot Victim

Mass shootings have changed the way trauma care at the scene of the shooting

09/26/17 All About the 2017-18 Flu Vaccine

The American Academy of Pediatrics (AAP) has released flu vaccine Preventive or Problem Based Visit?

WHAT IS A PREVENTIVE CARE VISIT? A Preventive Care Visit