Services

• New patients - complete the registration form below prior to appointment 
• Well Child Checks - complete the appropriate development form below prior to appointment
• Phone Nurse Triage
• Sick Visits
• Minor procedures
• Ear Piercing 
• Hospitalist Services at Columbus Community Hospital 

*****Forms completed electronically will be automatically and securely submitted to our clinic*****

Patient Consent and Authorization Form

• Patient Consent and Authorization 
• Patient Consent and Authorization - Spanish

Financial Responsibility Form

• Financial Responsibility 
• Financial responsibility form - Spanish

Notice of Health Information Privacy Practices & Acknowledgement of Receipt of Notice of Privacy Practices Form

• Notice of Health Information Privacy Practices & Acknowledgement of Receipt of Notice of Privacy Practices 
• Notice of Health Information Privacy Practices & Acknowledgement of Receipt of Notice of Privacy Practices - Spanish