Patient Forms

Wondering what you might need our what to expect out of your visit. To get some of those questions answered,

On your first visit, plan to spend the first few minutes filling out a patient information sheet, as well as reviewing and signing release and acknowledgement forms.  The forms are provided here for your review and convenience.  Also, a photo will be taken of you and stored in our records to assist in the prevention of identity theft.

 Patient Information Paperwork and Consents
Notice of Privacy Practices 09-23-2013

For patients who are uninsured or underinsured we offer a Sliding Fee Program which is based on household size and income.  Forms below. 

Sliding Fee Application (Bring proof of income with you)
Lab Fee Charges & Sliding Fee Scale for Medical & Behavioral Health
Dental Sliding Fee Scale
Women’s Clinic Sliding Fee Scale
Doniphan Urgent Care Sliding Fee Scale

What To Bring

Please bring these items with you for your first visit:

Completed forms (see above)
State Authorized Photo ID
Insurance Provider Card
Your current medications (prescriptions and over-the counter) in their original bottles.