Patient Forms

General Forms

• File

  Patient Statement of Rights and Responsibilities
• File

  Non-Discrimination Notice
• File

  Non-Discrimination Notice (Spanish)
• File

  Safety Notice
• File

  CMS/TDH Complaint Notice
• File

  Medical History Form
• File

  Patient Notification of Data Collection
• File

  Advanced Directives
• File

  Privacy Notice
• File

  Patient Rights Handout
• File

  Privacy Policy (Spanish)
• File

  Anesthesia Consent
• File

  Colonoscopy Consent
• File

  EGD Consent
• File

  Right to Receive a Good Faith Estimate of Expected Charges
• File

  Notice Regarding Patient Protections Against Surprise Billing