Patient Forms

Basic demographic information, contact details, emergency contact, and primary insurance information. Required for all new patients before or at your first visit.

Past medical history, surgical history, current medications, allergies, family history, and social history. Completing this before your visit means your appointment stays focused on your actual needs, not paperwork.

This form explains how Grace Care uses and protects your health information in accordance with HIPAA. You'll read and acknowledge receipt of our privacy practices. Required for all new patients.

Standard informed consent authorizing Grace Care to provide medical evaluation and treatment. This covers routine care, diagnostic testing, and minor procedures performed in office.

Outlines your financial responsibilities for co-pays, coinsurance, deductibles, and any non-covered services. Also covers our billing and collections policies. No surprises, just transparency.

Authorizes Grace Care to release your medical records to a specified third party, or to receive records from a previous provider. Required when transferring care or requesting copies of your records.

Required if you're scheduling a telehealth or video visit. Covers the scope of telehealth services, your rights, technology requirements, and limitations of virtual care. Complete this before your first remote appointment.

For patients under 18, a parent or legal guardian must authorize treatment. This form also allows you to designate another adult to accompany your child to appointments if you're unable to be present.

Use this form to update your insurance information if your coverage has changed since your last visit. Keeping this current helps us avoid billing delays and ensures claims are submitted correctly.