Patient Forms

For faster check-in, please print, fill out and bring to clinic. You must also provide drivers license or government-issued ID.

• Check-In Worksheet*
• Non-Coverage Consent (*required for Medicaid plans)
• Authorization to Release Healthcare Information Form
• Minor Form
• Flu Shot Questionaire
• TB Skin Test
• Hepatitis B Vaccination
• Pneumonia Vaccination

*required documents

Please call us if you have any questions. Visit our Contact Us page for location information.

LaPlace (985) 359-2273     Westbank (504) 393-2273