Patient Forms
Whether you are a new or current member of our network, here is where you’ll find all the forms and releases you’ll need to make your care as seamless as possible. If you are new to our network, please complete all of the following applicable forms and return them to us before or on the day of your first visit with your Advantage Health physician.
Please note that our forms require official signatures. You can print and fill out the forms by hand, or type in the required information, print and sign.
Privacy Policy
Patient Registration/Consent for Treatment/HIPAA
- Patient Registration/Consent for Treatment/HIPAA Form (English)
- Patient Registration/Consent for Treatment/HIPAA Form (Spanish)
- Patient Registration/Consent for Treatment/HIPAA Form (Vietnamese)
- Patient Registration/Consent for Treatment/HIPAA Form (Bosnian)
- Patient Registration/Consent for Treatment/HIPAA Form (Swahili)
- Patient Registration/Consent for Treatment/HIPAA Form (Nepali)
- Patient Registration/Consent for Treatment/HIPAA Form (Burmese)
Medical Record Authorization to Disclose Protected Health Information
- Medical Record Authorization to Disclose Protected Health Information Form (English)
- Medical Record Authorization to Disclose Protected Health Information Form (Spanish)
Treatment of Minor Consent
Deceased Patient Representative/Heir/Beneficiary Request
- Deceased Patient Representative/Heir/Beneficiary Request (English)
- Deceased Patient Representative/Heir/Beneficiary Request (Spanish)