For a quicker wait time, please download, print, fill out, and bring any completed forms you will need with you to the clinic.
New Patient Registration Form
Authorization to Release Healthcare Information Form
Click here for a PDF containing the following forms:
- Check-In Worksheet
- Advanced Beneficiary Notice of Noncoverage: Medicaid Patients
- Consent for Medical Treatment of a Minor
- Flu Shot Questionnaire
- Sports/School Physical Patient Registration
- TB Skin Test
- Hepatitis B Vaccine
- Pneumonia Vaccine
- Against Medical Advice
Please call us if you have any questions. Visit our Contact Us page for location information.
LaPlace (985) 359-2273 Westbank (504) 393-2273