Patient Forms

Below are some of the forms we require patients to fill out for appointments.

New and Annual patients have to fill out Medical History Forms. If you are requesting a pregnancy test, you must fill out the Pregnancy Test Request Form. If you want an STD test, please fill out the Express Client Information Sheet. If you have no insurance and are a citizen between 18 and 39 years old, please fill out the State Pap Plus Program Form for reduced to no-cost services of paps, labs, breast exams, etc.

Please download, print, and fill out these forms prior to your appointment to help reduce waiting room time.

For questions or to make an appointment, get in touch!

Patient Forms FHSI

English

Click links to view and download forms.

State Pap Plus Program Form (PDF)
Patient Consent Form (PDF)
Office Visit Form (PDF)
Wellness Exam Form (PDF)

Español

Haga clic en los enlaces para ver y descargar formularios.

Formulario del programa estatal Pap Plus — Español (PDF)
Formulario de consentimiento del paciente — Español (PDF)
 Formulario de visita a la oficina — Español (PDF)
Formulario de examen de bienestar — Español (PDF)