Patient Forms

PCMH Patient Compact

Patient Information

New Patient Forms

New patients can save time during their first appointment by completing the Patient Registration form prior to their visit. Simply print out the Patient Registration form, fill in the information requested, and bring the completed form with you to your appointment. 

Wellspire Financial Policy

We are committed to building a successful physician-patient relationship with you and your family. Your clear understanding of our Patient Financial Policy is important to our professional relationship. Please understand that payment for services is a part of that relationship. Please ask if you have any questions about our fees, our policies, or your responsibilities. It is your responsibility to notify our office of any patient information changes.

Wellspire Medical Records Request Form

The privacy of this information is protected by federal and state regulations. This means your medical information is only available to the Wellspire Medical Group health care professionals. Everyone else must get special permission (called authorization) before the information can be released. To get a copy of your medical record is simple: just fill out, download, print, and sign the form.