Forms
At PriMED, we want to make your visit as smooth and efficient as possible. To help you save time at check-in, we provide our most common patient forms online. Simply find the form you need below, print it, and complete it before your appointment.
Bringing your completed forms with you helps our team prepare for your visit and allows you to focus on your conversation with your provider.
General & New Patient Forms
These forms are designed to gather essential information to ensure we provide you with the best care possible.
Consent to Treat
This standard form is required for all patients of our Family Practice and Neurology offices. It authorizes our team to provide you with medical care.
Download the Consent to Treat form.
Consent to Treat – Alternate Request
If you are a parent or legal guardian of a patient under 18 and another adult will be bringing your child to their appointment, please complete this form. It allows the designated adult to consent to treatment on your behalf.
Medical History – Family Practice
For new patients or those with significant health updates, this questionnaire helps us build a complete picture of your health. Your physician will review this with you during your visit.
Download the Medical History – Family Practice form.
Medical History – Pediatrics
Please complete this form for your child before their first visit. This comprehensive history helps our pediatric team understand your child's health from the very beginning.
Download the Medical History – Pediatrics form.
Medical History – Neurology
Prior to your first neurology appointment, please complete this form. It allows the doctor to review your past and present medical information, making your initial consultation more productive.
Specialty & Records Forms
These additional forms may only be necessary for some of our patients.
Diabetic Eye Exam Form
If you are a patient with diabetes, it is important to have an annual eye exam. Please have your eye doctor complete this form and bring it to your next appointment with your primary care provider.
Download the Diabetic Eye Exam form.
Transfer Patient Records
Use this form to request that your medical records be sent from a PriMED office to another physician or facility. You can also use it to request that another provider send your records to us.
Advance Directives
An Advance Directive is a legal document that allows you to communicate your decisions about end-of-life care in advance. It gives you a voice in your medical care if you become unable to speak for yourself.
