Forms for Patients

Complete Patient Forms Online

Speed up the check-in process at Bayless Healthcare by completing your medical forms in advance of your appointment. It’s easy and more accurate, and you can keep personal copies of the forms for your own records.

Instructions:

  • Simply click on the link below to access the PDF form.
  • Type your information directly into the form.
  • When you are finished, print out a copy and bring it with you to your medical appointment.
  • You may also save the form on your computer at any time. If you need more time to complete the form, save it so you can come back to it later and finish up.
  • When all the information is complete, you may save and/or print a copy for your records.

Adult Patient Packet
Includes:

  • Patient Registration Form
  • Consent for Treatment Form
  • Financial Policy and Patient Responsibility
  • Release of Health Information Consent
  • Consent for PCP Two-Way Release / Request of Protected Health Information
  • Patient Financial Information and Uniform Data Set
  • Notice of Privacy Practices Patient Rights
  • Advance Directive Form
  • Community-Based Crisis Contact Information
  • Grievance Policy
  • Advance Directive Resources

Download Adult Forms English

Download Adult Forms Spanish

Health Information Exchange Opt-In English

Health Information Exchange Opt-In Spanish

Health Information Exchange Opt-Out English

Health Information Exchange Opt-Out Spanish

Child Patient Packet
Includes:

  • Patient Registration Form
  • Consent for Treatment Form
  • Financial Policy and Patient Responsibility
  • Release of Health Information Consent
  • Consent for PCP Two-Way Release / Request of Protected Health Information
  • Patient Financial Information and Uniform Data Set
  • Notice of Privacy Practices Patient Rights
  • Community-Based Crisis Contact Information

Download Child Forms English

Download Child Forms Spanish