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Forms

For your convenience

We’ve collected the various forms and informational materials you may need when visiting our offices. If you have any questions or concerns, please contact us.

Please click on any of the links below to download a pdf copy of the forms to complete before your visit. The requested form will open in a new page, where you can print it or download it to your computer. If you do not have access to a printer, you can stop by your doctor’s office to pick up a copy, or plan on arriving for your appointment a few minutes early to take care of the paperwork.

New Patient

Wellness Visit

Records


Physicals


Financial


Assessments


Advanced Directives


Orange County School Telehealth ONLINE Sign Up Forms

SignUp Page with Instructions and Telehealth program details


Orange County School Telehealth PRINT Sign Up Forms

• HIPAA Form
• Telehealth Consent Form
• Telehealth Enrollment Form (New Patient) – Pediatric (under 18yrs of Age)
• Telehealth Enrollment Form (New Patient) – Adult (over 18yrs of Age)
• CHAP Assistance Form
• Proof of Identity and Insurance Form

 

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