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.
Family Practice
Printable Forms
View online or download and print to complete before your visit.
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.
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.
Download our form to transfer patient records for family practice.
Forms for Review Only
You'll be asked to sign these forms in-office when you arrive to your appointment.
Pediatrics
Printable Forms
View online or download and print to complete before your visit.
Medical History – 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.
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.
Download the Consent to Treat – Alternate Request 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.
Download our form to transfer patient records for pediatrics offices.
Vaccine Policy/Schedule -
Download the Vaccine Policy/Schedule.
Forms for Review Only
You'll be asked to sign these forms in-office when you arrive to your appointment.
- Patient Authorization for Personal Representative/Privacy Notice
- Notice of Privacy Practices
- Consent to Treat
- Understanding your Preventative Visit with Copays
- Missed Appointment Acknowledgement
Neurology
Printable Forms
View online or download and print to complete before your visit.
Medical History – 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.
Download the Medical History – Neurology 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.
Download our form to transfer patient records - neurology.
Forms for Review Only
You'll be asked to sign these forms in-office when you arrive to your appointment.
