Patient Medical Forms

Want to save time during your visit with us? Please print and fill out the following forms and bring them with you on your appointment.

 

Medical Forms:

GENERAL FORMS:
Welcome Packet
HIPPA Privacy Notice
Nurse Visit Information
Follow My Health
Consent to Treat Minors
 
ADVANCE DIRECTIVES:
Advance Directives
Five Wishes
Power of Attorney
 
ADD/ADHD FORMS:
ADHD Questionnaire
Pediatric ADHD (Vanderbilt) Screening For Parents
Pediatric ADHD (Vanderbilt) Screening For Teachers
Adult ADHD Screening
 
DEPRESSION SCREENING:
Adult Depression Screen
PHQ-9
 
EPWORTH SLEEPINESS SCALE:
Epworth Sleepiness Scale – Link 1
Epworth Sleepiness Scale – Link 2
 
RECORD RELEASE FORMS:
Record Release From Lone Tree Family Practice
Record Release To Lone Tree Family Practice
 

 

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