PATIENT FORMS

Complete Packet – NEW PATIENTS

 

NEW PATIENT – GRETNA

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

NEW PATIENT – WESTWEGO

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

NEW PATIENT – O'NEAL

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

NEW PATIENT – PERKINS

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

Individual forms

 

l

patient information form

l

Responsibility for Payment and Receipt of HIPAA Notice

l

HIPAA Notice of privacy act

l

Designation of personal representative

l

Consent for Treatment PCP

l

GRETNA LOCATION PHI release

Authorization for the Release of Protected Health Information
Download PDF (226 KB)

l

WESTWEGO LOCATION PHI release

Authorization for the Release of Protected Health Information 
Download PDF (226 KB)

l

O'NEAL LOCATION PHI release

Authorization for the Release of Protected Health Information 
Download PDF (226 KB)

l

perkins LOCATION PHI release

Authorization for the Release of Protected Health Information 
Download PDF (226 KB)

Your source for primary care doctors in Baton Rouge, Gretna and Westwego. Primary Care Plus is a healthcare clinic dedicated to patient health through continuity of care.