Forms

Promenade Healthcare is happy to include forms used in our practice to collect information on our patients for demographic use as well as medical information. Each form listed below is in PDF Format.

New patients will need to arrive 30 minutes ahead of their scheduled appointment times for the completion of all necessary paperwork. New patient and annual patient forms are located below to give patients an opportunity to have most of the required forms completed before their visit.

Established patients need to arrive 15 minutes prior to their scheduled appointment to allow adequate time for completion of required forms and update any demographic information. All patients are required to sign a new HIPAA Consent Release form each year. If patients want to transfer their care to Promenade Healthcare, they would choose Medical Records Request below and complete that form to transfer records to our office. If patients are transferring their care from Promenade Healthcare, they would choose the Medical Records Release form below and follow the directions on the form.

HIPPA Notice of Privacy Practices

PDF

click to download

Download PDF

Patient Health History Female

PDF

click to download

Download PDF

Patient Health History Male

PDF

click to download

Download PDF

Release of Medical Information

PDF

click to download

Download PDF