Forms
Below are the necessary forms you will need to complete for your visit.
Below are the necessary forms you will need to complete for your visit. We prefer that you fill them out and submit them online to limit your waiting time and to give us time to better review your medical history. If you prefer, you can print them, fill them out by hand and bring them with you to your appointment 15 minutes ahead. If you prefer to fill out paperwork in our office, please plan to arrive 30 minutes before your appointment time.
Click the link for the set of forms that fits your appointment type:
- New Patient (infant to 10 years old)
- Paciente nuevo (Infante hasta 10 años)
- New Patient (11 years old to 64 years old)
- Paciente nuevo (11 años a 64 años)
- New Patient (65 years old or older)
- Paciente nuevo (65 años o más)
- For Established Patients having Wellness Exams/Physicals
- Para pacientes establecidos que tienen exámenes de bienestar / exámenes físicos
New Patients having Wellness Exams/Physicals, please fill out the forms above that fits your age group. We will contact you if other forms are needed.
Medical Records Releases
- Request your records be sent to us
- Solicite que nos envíen sus registros
- Send your records elsewhere – there is no charge for records to be sent to another medical office, but otherwise our copy service will send you a bill.
- Envíe sus registros a otro lado
Other Forms
COVID Financial Consent
Consent to Treat a Minor
Consentimiento para tratar a menores
HIPAA Privacy Policy
Practicas de privacidad y derechos de los pacientes
Thank you for choosing North Coast Family Medical Group to provide your healthcare needs. If you have any questions, please call us at (760) 942-0118. We look forward to seeing you!
