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Electronic Patient forms

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All new patient forms can be completed during the check-in process

New to ClearPath Family Healthcare?  

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HIPAA Authorization Form

Use this form to authorize how we may contact you or who should have access to your records

Medical Record Request Form

Use this form to authorize the release of your medical records or request records

Portal Request

Use this form to request portal access or to reset your portal password

Simple & Fast!

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Consent to treat a minor

Use this form to allow medical treatment of a minor when a parent or guardian is unavailable

Behavioral Health Informed Consent

Use this form to allow medical treatment of a minor when a parent or guardian is unavailable

Physical Care Informed Consent

Use this form to allow medical treatment of a minor when a parent or guardian is unavailable

Everything in one place!

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Depression Screening (PHQ 9)

Use this form to identify signs of depression

Anxiety Screening (GAD 7)

Use this form to identify signs of anxiety

Social Determinants of Health (SDOH)

Use this form to help identify and remove barriers to your medical care

Save time and complete everything online!

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