Clinic Forms
Required Forms for All Clinic Visits
- Registration - English (PDF)
- Registration - Spanish (PDF)
- HIPAA Authorization - Spanish (PDF)
- HIPAA Authorization - English (PDF)
- Acknowledgement of Receipt of Privacy Practices (PDF)
- Notice of Privacy Practices - English (PDF)
- Notice of Privacy Practices-Hmong (PDF)
- Notice of Privacy Practices-Spanish (PDF)
Immunization Forms
- Screening Checklist for Contraindications to Vaccines for Adults - English (PDF)
- Screening Checklist for Contraindications to Vaccines for Adults - Spanish (PDF)
- Screening Checklist for Contraindications to Vaccines for Children and Teens - English (PDF)
- Screening Checklist for Contraindications to Vaccines for Children and Teens - Spanish (PDF)