Fast Track Medical Forms

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Medical Forms

Print and fill out these medical forms and bring them with you to expedite your check-in process.

FormEnglishSpanishChinese
Patient RegistrationDownload Patient RegistrationDescargar下載
Advance Beneficiary Notice (ABN)Download Advance Beneficiary NoticeDescargarN/A
Patient Consent Form (HIPAA)Download Patient Consent FormDescargar下載
HIV Consent FormDownload HIV Consent FormN/AN/A
Medical Release FormDownload Medical Release FormN/AN/A
Medical HistoryDownload Medical HistoryN/AN/A

Paying by Credit Card?
Please fill out this form, bring it with you, email or fax it to us.

Credit Card Authorization FormEnglishN/AN/A

What you’ll need on your visit:

All current insurance cards
One (1) Official picture ID (Driver’s license, passport…)
Co-pay is expected prior to being seen, no personal checks acceptable.
Please arrive on-time

Schedule a Tour

Ambulance Service Provided By: