Plumtree Family Health Center - Patient Documents

Patient Documents

Patients have the option to complete online forms or print forms to complete and bring with them. If you would like to do online - you should complete the 3 blue links below.

You should upload a copy of your insurance card and photo ID while completing the form. If you are unable to upload, please email a copy to PlumtreeRecords@plumtreehealth.com

NEW PATIENT ONLINE FORMS - EFFECTIVE 08/13/20

MEDICAL HISTORY - PART 1

You do not need to print and complete the GRAY forms below if you completed the online forms above.

For NEW Patients; Please complete all 5 forms prior to visit.

Patient Info Packet- Updated 10/10/14- Applies to new and current patients

1. Patient Registration Form

2. Financial Agreement

3. Protected Health Information Release

4. Patient History Form

5. Release to release records TO Plumtree from another provider

This form should be used if you are sending your child to a visit at our office and you will not be present.

Consent to Treat Minor