Patient Forms

For your convenience, the following patient forms are available for you to complete before your appointment. Please complete, print, and bring these forms to your appointment.

Patients under 18: Please complete the Pediatric Patient Registration

Patients over 18: Please complete the Adult Patient Registration Form

New Patient Forms:

• Adult Patient Registration Form
• Pediatric Registration Form
• Privacy Policy

Other Forms:

• Advance Directive Form
• Release of Records Request (Request to obtain medical records from another practice to HT Family Physicians)
• Authorization to Release Medical Records (Authorization for HT Family Physicians to release records to a another practice)
• Notice of Nondiscrimination

Please Bring the Following Items to Your Appointment

• Insurance Card – If you don’t have your Insurance Card, payment will be required at the time of your visit.
• Immunization Record
• Photo ID/ Student ID – If available
• Prescription Bottles
• Vitamin Bottles

This information will enable the physicians and staff at HT Family Physicians to better serve you.

Thank you for your assistance,

HT Family Physicians Inc.