The Family Doctors


Consent for Treatment Please complete this form to authorize treatment. Privacy Acknowledgement Form Please print and complete this form prior to your visit. This form inidcates you have reveiwed our Notice of Privacy Practice, listed upder "Patient Privacy". Please give the completed form to our registration receptionist upon arrival. Designation of Personal Representative You have the right to designate someone to have access to your health care record. This access may include obtaining results, setting up appointments or obtaining referral authorizations. If you are interested in having someone designated, please print and complete this form prior to your appointment. Authorization to Release/Obtain Information Please complete this form if we need to obtain medical records from another physician or health care facility. Male Osteoporosis Screening Questionnaire If you are having a bone mineral density test and would like to complete the required paperwork prior to your arrival, please print and complete the form now. Female Osteoporosis Screening Questionnaire If you are having a bone mineral density test and would like to complete the required paperwork prior to your arrival, please print and complete the form now.