Patient Forms

IMPORTANT

NEW PATIENTS: Please download, print, and complete the appropriate forms based on your appointment type. Bring the completed forms with you to your visit. If you are unable to print and complete your forms in advance, please plan to arrive at least 15 MINUTES before your scheduled appointment to complete the required paperwork in the office.

PLEASE NOTE: All new patients are required to complete new patient paperwork, either in advance or upon arrival.

Download patient forms by clicking the links below.

New Patient Forms

CareMedica Registration Form

Authorization to Release Information

Patient Medical History Form

CareMedica Notice of Privacy Practices

CareMedica Notice of Practice Policies

Annual Screening

Annual Screening Questionnaire

Social Determinants of Health Questionnaire

Other forms

CareMedica Patient Treatment Contract

CareMedica AI Consent Form

Physical Examination

General Anxiety Disorder (GAD-7) Questionnaire

Depression Screening (PHQ-9) Questionnaire

Tobacco Questionnaire

Alcohol Screening (Audit-C) Questionnaire

Review of Systems Questionnaire

SPANISH Translated CareMedica Forms

Audit-C Form [SPANISH]

GAD-7 Form [SPANISH]

PHQ-9 Form [SPANISH]

Tobacco Control Form [SPANISH]

Social Determinants of Health (SDOH) Form [SPANISH]

CareMedica Policies [SPANISH]

CareMedica Patient Treatment Contract [SPANISH]

CareMedica Patient Medical History Intake Form [SPANISH]

Review of Systems Questionnaire [SPANISH]

Get More Info

First name:

Last name:

Phone Number:

Email:

New or Existing Patient:

CareMEDICA Office:

Reason for your inquiry:

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