Patient Forms And Information

Patient forms need to be printed, filled out and brought to the office. Please do not submit your forms through the website.

To save time on the day of your appointment, please fill out these forms and bring them with you:

Forms – English 

• CDLS Patient Registration Form
• CDLS Patient Health History Form
• Authorization to Release Healthcare Information
• CDLS Financial Policy
• Consent to Treat a Minor
• Notice of Privacy Practices
• Results Form

Forms – Spanish

• CDLS Patient Registration Form (Spanish)
• CDLS Patient Health History Form (Spanish)
• Authorization to Release Healthcare Information (Spanish)
• CDLS Financial Policy (Spanish)
• Consent to Treat a Minor (Spanish)
• Notice of Privacy Practices (Spanish)
• Results Form (Spanish)
• Modernizing Medicine Instructions (Spanish)

Please do not fill out any patient paperwork from the portal, this does not get to the office please see patient forms on this website to print, complete, and bring to the office with you.

 

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