Patient Forms

There are several forms that may be required for your appointment at OFHC. Filling them out ahead of time and bringing them with you may speed up the time needed before you can see your health care provider.

You will need a .pdf viewer program such as Adobe or Foxit Phantom to view and print these forms.

(All materials are available in Spanish at the office.)


As required by HIPPA, all new patients must review the Privacy Practices. To view the Summary of Privacy Practices click on the link:
Summary Notice of Privacy Practices-1

All new patients must sign the acknowledgement form stating that they have reviewed the Privacy Practices. Click on the link, print the form, fill it out and bring it with you to your appointment:
Acknowledgement of Receipt of Privacy Practices-1


All new patients must fill out the Health Questionnaire. Click on the link, print the form, fill it out and bring it with you to your appointment:
New Patient Health Questionnaire

All new patients and existing patients whose insurance has changed since their last visit must fill out the Patient Information and Financial Policy / Demographics form. Click on the link, print the form, fill it out and bring it with you to your appointment:
Patient Demographics Updated 2018-2


New patients or those who have been seeing a health care specialist may transfer their health care records to OFHC. You will need to fill out a Release of Information form authorizing your previous provider to send your records to OFHC. Click on the link, print the form, fill it out and bring it with you to your appointment:
INFO RELEASE TO OFHC ROI Authorization 2017-1


Existing patients that wish to have OFHC transfer their health care records to a new health care provider or specialist may fill out a Release of Information form from OFHC. Click on the link, print the form, fill it out. You may mail it or drop it off at OFHC and we will send your records as directed. Or you may take the form to your new provider and have them request the transfer.
OFHC TO OUTSIDE Authorization to Release Health Care Information-Revised 31708-1

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