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Online Forms and Policies

Online Forms and Policies FAQ:

New Patient Form: New Patient form for individuals to fill out who are new HIMG prior to the first appointment.

Financial Policy:  Answers questions regarding patient and insurance responsibility for services rendered. 

Medical Records Release: Medical Records Release for patients to fill out and sign for release of their individual medical records for other physicians and personal use.

Protected Health Information Release to Family Members: Release for patients to sign for family members or designated individuals to receive Protected Health Information (PHI) on in person, on the phone or electronically.

Request for Confidential Communications : Request for patient to receive alternate forms of communication from HIMG for reasons of confidentiality.

Parental Consent for Treatment of Minor Children :  Grant permission for responsible adult to seek medical care for your minor child in your absence.

Annual Wellness Visit Forms :  Prepare for your upcoming Medicare Wellness Visit.

HIMG Center for Heart Function Blood Pressure Log : Assist your provider in treating your heart by tracking your blood pressure readings.