Patient Forms

Having a list of questions and symptoms to discuss will help you walk out of your doctor's office better informed about your healthcare and condition. Your doctor will also appreciate that you have times and dates of symptoms written down, and do not have to rely on your memory.

Here are some patient forms your physician may have asked you to bring to your appointment:

Patient Information

Authorization to Speak to Another Regarding Medical Care

Consent for Financial Responsibility

General Consent to Treatment

Authorization for Access or Release of Protected Health Information

HRPAS Consent to Access External Prescription History

Contact Us

For more information, call 1-800-818-4747 or complete our online contact form.

Like Us on Facebook!

Like our Facebook page to stay up to date on news and events.
Learn More >
Schedule a Test

We offer a wide variety of outpatient services and testings.
Learn More >

Read our blog
Catch up on our stories and news.
Read more >
Like us on Facebook
Follow Holy Redeemer for the latest community news!
Learn More >