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  • Center for Primary Care Patient Forms | Center for Primary Care

CPC Patient Forms

Registering As A New Patient

You will need to complete several forms as part of the new patient registration process before seeing your CPC physician for the first time.

To register prior to your appointment, please complete, sign, and mail the following forms to your new physician's office or bring them with you prior to your first appointment. When you check in you will receive a copy of our office policies which you will also be asked to review and sign. PLEASE ARRIVE AT LEAST 30 MINUTES EARLY FOR YOUR FIRST APPOINTMENT.

New Patient Information

Health History

Privacy Policy

Privacy Policy Acknowledgement and Authorization

Use and Disclose PHI

If you have questions about the registration process or your first appointment, please contact the office where you will be seen. Please remember to bring your current insurance card and any medications that you are currently taking with you to your first appointment. Thank you again for choosing CPC. Your health is in good hands!

Should I transfer my care to a CPC physician now or wait until the next time I need to see a physician?

If you have made the decision to transfer your care to a CPC physician, we recommend you do so at your earliest convenience rather than waiting until you are sick. This allows us to have all your medical information on hand at the time of your first appointment in order to provide more personalized care.

Requesting Copies of your Medical Records*

To have your medical records sent to CPC from another practice, please provide the following form, completed and signed, to our office so we can obtain a copy of your record prior to your first appointment at CPC.

Patient Authorization for Release of Medical Records to CPC

To request that a copy of your medical records at CPC be released to another person or practice, please provide the following form, completed and signed, to our office.

Patient Authorization for Release of Medical Records from CPC

*Note: CPC does not charge for sending records to another doctor for healthcare purposes (eg, referral appointment, transfer to another doctor), but there may be a charge for copies requested for other purposes.

UPDATING YOUR PERSONAL INFORMATION

Have you recently moved, changed insurance plans, or do you have a new phone number or e-mail address? If so, please help us keep our records up-to-date by completing the relevant information on the following form and providing a copy to your doctor's office.

Patient Information Update