Patient Forms
- Lifetime Assignment of Benefits / Release of Information [PDF - 99 KB]
- Statement to Clinton Service Unit Patients [PDF - 139 KB]
- New Patient Chart Application [PDF - 350 KB]
- Certification of Original Document Copies [PDF - 172 KB]
- Acknowldegement of Receipt of IHS Notice of Privacy Practices[PDF - 203 KB]
- Notice of Privacy Practices [PDF - 1 MB]
- Advance Directive Policy Confirmation [PDF - 233 KB]
- Medicare Secondary Payer Questionnaire [PDF - 482]
- Purchased Referred Care - Residency Verification [PDF - 720 KB]
- Appointment Reminder Messages - Opt in/Opt out [PDF - 623 KB]
- Advance Directive Information [PDF - 150 KB]