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patient forms

All forms below will open in PDF format when clicked.

Patient Registration Packet
Vasectomy Registration Packet
Erectile Dysfunction (ED) Registration Packet

Medication Listing - For your convenience to print a copy for your records

Ward of the State Authorization
Parental Authorization Form - Required for minors visiting the clinic without a parent or guardian

Release of Medical Records - Required for release of any Protected Health Information (PHI)
HIPAA Privacy Notice
Receipt of Privacy Notice
HIPAA Restrictions

Patient Bill of Rights
Patient Rights and Responsibilities