Patient Forms

Forms for Patients

Complete Patient Forms Online

Speed up the check-in process at Bayless Integrated 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 Forms

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 forms:

Child Forms

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 forms:

Improving lives, transforming healthcare