|Adult New Patient
For adults (age 16+) with a new patient appointment
Pediatric New Patient
For children (age less than 16) with a new patient appointment
Receipt and Notice of Privacy Practices (HIPAA)
Describes how medical information about you may be used and disclosed and how you can access this information. HIPAA requires all patients to complete this form.
Form authorizing healthcare provider to release your medical information to Sierra Providence Medical Partners
Explains Sierra Providence Medical Partners' payment of services
Red Flags Payment Permission Form
Form authorizing a patient the use of Medical Flex card, personal credit card, or personal check to pay for the services that they receive at Sierra Providence Medical Partners
Consent for Treatment
Form giving Sierra Providence Medical Partners consent to give you treatment
ADULTS | PEDIATRICS
Medical Information Release
Authorizes Sierra Providence Medical Partners to release your medical information to specific entities.
Frequently Asked Questions
HIPAA as it relates to our patients.
Request for Correction / Amendment to Record
Allows you to request a correction / amendment to your medical record.
Know Your Benefits
This pamphlet can assist you in learning about your insurance benefits, including questions to ask your provider.
Preparticipation Physical Evaluation Form
This form is for Sports Physicals
Immunization Registry Consent Form
Allows schools to verify records