All of our forms are conveniently available for you to view and print. If you are new to our practice, we ask that you fill out a new patient packet prior to coming to your appointment to save time during the check in process.
New Patient Packet
If you are a new patient to our office, Post Falls Family Medicine requires you to fill out the following forms: Patient Demographic, Pre-History, Release of Information, No Show Policy, and a Notice of Privacy Practice (HIPAA) form.
This form is required of all patients because it authorizes Post Falls Family Medicine to release medical, billing and appointment information to family members in lieu of the patient. It also authorizes us to leave lab results on a voicemail or answering machine if the patient authorizes us to do so. Signing this form also acknowledges that you have read and understand our no show/missed appointment policy.
Authorization to Release Medical Information
This form allows Post Falls Family Medicine to release your medical records to another physician's office.
Authorization to Receive Medical Information
This form allows Post Falls Family Medicine to request your records from another physician's office.
Notice of Privacy Practices/HIPAA
This form documents the patient's receipt of the Notice of the Privacy Practices/HIPAA.
This is required for new patients or patients that are re-establishing care with our office.
We have mainstreamed our demographics for families that have more than one child, you now only need to fill out one demographic form for multiple children.
This form gathers past medical history on new patients or patients who have not been in the office recently. This past medical history includes family illness, past and current medications, surgeries and selected procedures as well as social activities with risk factors.
Consent for Vasectomy
Coumadin (Warfarin) patient agreement
Sports Physical Form
Pain Management Agreement