Patient Forms

All Patient Forms are provided below. We require you to fill in the form(s),  print and sign, and then bring them with you to your next visit and/or surgery. This will help expedite the registration process and reduce your wait time in the clinic.

To download any of the forms, simply click on it and it will open up in a new tab. Again, type in your information, print, sign and bring the completed forms with you to your visit.

• Patient Registration PDF
• Patient Billing Policy PDF
• Female Questionnaire PDF
• Male Questionnaire PDF
• Pediatric Adolescent Questionnaire PDF
• Records Release Request PDF
• Release of Medical Information Form PDF
• EmpowerRF Financial Policy PDF