Forms – Multicare Health Center

Please take a moment to fill out the appropriate paperwork. We are continually striving to make your visit more enjoyable and your wait time easier please take a moment to fill out the appropriate for in advance of your appointment. We are continually striving for the best way to serve you. Please let us know if you have any questions. Some of the links on this page may require Adobe Reader to view them. The Adobe Reader is available for download free of charge, by clicking on the logo.

NEW PATIENT INFO

New Patient Registration

Hippa Sign Form

Assignment of Benefits

Patient Request for Records

Patient Request for Records

Consent to Treatment of Minors

Consent to treatment of minor child

WORK, AUTO, SLIP & FALL INFO

Workers' Compensation Forms

Worker Compensation Information

Financial Agreement Workers Compensation

Hippa Sign Form

Assignment of Benefits

Patient Request for Records

Vehicle Accident Forms

Vehicle Accident Information

Financial Agreement Personal Injury

Hippa Sign Form

Assignment of Benefits

Patient Request for Records

Slip & Fall Injury

Slip & Fall/Injury Information

Financial Agreement Personal Injury

Hippa Sign Form

Assignment of Benefits

Patient Request for Records

NEW DIETER & I LIPO INFO

Health Profile

Consultation Agreement Fee

Informed Consent Form

Authorization And Consent

Primary Care Doctor Form

Alcohol Consumption Agreement

i-lipo Forms

i-Lipo Treatment Guide

Client Medical Consultation/ Treatment Record

MISCELLANEOUS

Massage Form

Orthotic Instructions

Orthotic Instructions

Ion Cleanse

EMG/ Nerve Conducting Test