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Learn more and get the forms

Patient forms to help make the best of your appointment
Patient Forms
Please Complete the paperwork listed below and bring to your appointment

Print and complete forms 1-4 for general information then use the following links for the forms that apply to you.

  • Privacy Practice.docx

    Please read and sign the Acknowledgement and consents

  • FTLOH Consent and Financial policy.docx

    Please Print, sign, and bring to your appointment

  • Patient Rights & Responsibilities.docx

    Please, Read, Print, Sign, and bring to your appointment

  • Records request.docx

    Please print, complete, and bring to your appointment.

  • Health History (Adult).docx

    Pleae Print and complete to the best of your ability. Bring to your appointment.

  • Pediatric New Patient forms.docx

    Please Print, complete to the best of your ability and bring to the appointment

  • DPC Pricing.docx

    Direct payment Care/Subscription medicine.

Additional Forms
Please Complete the forms that apply and bring to your appointment

WE ARE HERE TO HELP!

  • GAD-7.pdf

    Generalized Anxiety Disorder Screening tool

  • Patient Health Questionnaire (PHQ-9).pdf

    Depression screening test

  • scared-form-parent-and-child-version.pdf

    Please complete the parent and child forms and bring to your appointment

  • adult adhd assessment.pdf

    Please print, complete, and bring to your appointment.

  • Vanderbilt Teacher.pdf

    Pleae Print and complete to the best of your ability. Bring to your appointment.

  • Vanderbilt Parent.pdf

    Please Print, complete to the best of your ability and bring to the appointment

  • Blood Glucose Logs.docx

    Please keep track of your blood sugars and bring your log to every appointment

  • Blood pressure logs.docx

    Please keep track of your blood pressure and bring your logs to every appointment.