Forms

 

 

 

Download
Hearthside Health History Form- Please feel free to print and fill out, however we will review all of this at your first visit.
Hearthside_new_patient_history_form.doc
Microsoft Word Document 470.5 KB

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Privacy Notice- You do not need to print. When you sign up it will ask that you have reviewed this. Please review the document click yes.
Hearthside Notice of Privacy.docx
Microsoft Word Document 42.5 KB

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Hearthside Record Release Authorization
This is a release of information to receive previous records, or disclose records to another practice.
1pg 9-13-2018Hearthside Release of Recor
Microsoft Word Document 132.5 KB
Download
Hearthside Record Release Authorization
This is a release of information to receive previous records, or disclose records to another practice.
Direct Primary Care Membership Agreement
Adobe Acrobat Document 207.7 KB