Patient Forms

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