Patient Forms

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

• New Patient information Form*
• Check In Worksheet*
• Proof of Insurance Form*
• Authorization to Release Healthcare Information Form
• Minor Form
• Flu Shot Questionnaire
• Sports/School Physical Patient Registration
• TB Skin Test
• Hepatitis B Vaccine
• Pneumonia Vaccine

*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