Patient Forms

Registration Form

Health History Questionnaire

Patient Record of Disclosures

Authorization To Release Healthcare Information

 

Motor Vehicle Accidents Forms

Doctor's lien

REGISTRATION FORM

HEALTH HISTORY QUESTIONNAIRE

PATIENT RECORD OF DISCLOSURES

AUTHORIZATION TO RELEASE HEALTHCARE INFORMATION

Motor Vehicle Accidents: If you have hired an attorney for your accident, please have the "Doctor's Lien" form signed by you and your attorney prior to your visit

Forms for Patients

Please select and complete the applicable forms below before your first visit. For your convenience, the forms are fillable and you may email them to us at pacesferrymedicalgroup@yahoo.com before the day of your visit or bring them in with you the day of your visit.

 

Preparing for your Appointment

  1. Make a list of your health questions. Ask a friend or relative for help if you need it. Put the questions that are most important to you at the top of the list. Even if you cannot get all of your answers on the first visit, having a list will help you keep track of the answers.

  2. Talk with your provider about what health issue to work on first.

  3. Make a list of other health care providers you have visited. Write down their names, addresses, phone numbers and the reasons you visited them.

  4. If this is your first visit to this provider, take all of your medicines, in their original containers, to your appointment. Be sure to include prescription, over-the-counter, natural and herbal medicines and vitamins.

  5. Make sure you know what you should do before you leave the office.

  6. Use your own words to repeat back the things you've discussed with your provider. This way both you and your provider will know the information given to you is clear.

  7. Ask how to reach the providers in the office after hours if needed.

  8. Before you leave the office, be sure you know the things you need to work on before your next appointment; and be sure to schedule your next appointment at this time.