Health Forms

The following is a selection of forms that you may find convenient to have for your next visit to your physician or in case of an emergency. Print off and fill out the ones that are more important to you and keep in a convenient location.

• Medical Records Request
• Universal Medication Form
• Adult Medical History Form
• Medical Practices Pediatric Intake Form
• Medical Practices Adult Intake Form
• Clinic-Registration-Information
• Activities of Daily Living Scale (LADL)
• Fall Risk Assessment 
• Hearing Screening Form
• Patient Health Questionnaire
• Home Safety Questionnaire

Advance Planning for your healthcare is important and these forms can help. Discuss your wishes with your family and friends.

• Health Care Proxy
• Living Will
• Do Not Resuscitate
• Medical Orders for Life Sustaining Treatment: End of Life & Palliative Care Planning

Medicare Forms

Welcome to Medicare: Medicare & You

Medicare Wellness Exam

Subsequent Medicare Wellness Exam

Not health forms, but still handy to have available on-line!

• Employment Application
• Sleep Disorder Quiz