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*****

Section 1: Registration Forms

All new patients or patients who have not been seen in our clinic within the last 3 years must fill out the registration form before the appointment

• Registration Form - English
• Registration Form - Spanish

Section 2: Policies

The following three forms must be filled out by all patients once a year.

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

Patient Consent and Authorization Form

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

Section 3: Forms by Age

Please fill out the appropriate forms based on the patient's age and/or type of appointment.

Sports Physical Form - All sports & band participants

• Sports Physical Questionnaire

Adolescent Form - 11 years and older

• Adolescent Questionnaire