Registration Form (English)

Patient Registration Form (English)

ESPAÑOL REGISTRO NUEVO

Registration Form Spanish

Protected Health Information Release Form

This is your authorization to request or release your medical records. Download and complete this form. Return it to your provider's office location for processing.

Alternative Communication Release and Right to Share

The Alternative Communication and Right to Share form identifies how you authorize your physician’s office to contact you, as well as with whom you give authorization for your protected health information to be discussed.

Privacy Notice Form

Privacy Notices form is used for assignment of insurance benefits and statement of financial responsibility in addition to acknowledgement of the privacy notices of St. Anthony's Primary Care, Inc.

New Patient Questionnaire

This form can be printed and completed before your new patient visit with your doctor.