(Translated by https://www.hiragana.jp/)
Patient Forms - Center for Healthy Living - Purdue University
Center for Healthy Living

Patient Forms

NEW PATIENT FORMS

  1. New Patient Health History Form
  2. Patient Information Sheet
  3. HIPAA Information and Privacy Consent Form
  4. One to One's Notice of Privacy Practices & Acknowledgement
  5. Authorization for Release of Medical Records Form

FOR MINORS ONLY

  1. Consent to Treat a Minor
  2. Permission to Accompany a Minor