We are excited that you have chosen Primary Care Partners for your medical care! Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.
The following documents and forms can be downloaded to your computer and printed out. By completing the forms ahead of time, you can save a significant amount of time during your visit. Please bring the filled in and signed forms, along with your current insurance card, to the physician's office at the time of your initial visit.
- Authorization for Release of Information
- Authorization for Release of Information - Spanish
- Authorization to Bring Minor
- Authorization to Bring Minor - Spanish
- Adult Patient Registration Form
- Adult Patient Registration Form - Spanish
- Child Patient Registration Form
- Child Patient Registration Form - Spanish
- Consent for Email Communication
- MyChart - Adult Proxy Authorization
- MyChart - Child Proxy Authorization
- MyChart - Minor Proxy Authorization
- Newborn Insurance Reminder
- Newborn Insurance Reminder - Spanish
- Notice of Privacy Practices
- Notice of Privacy Practices - Spanish
- Nutrition Counseling Intake Questionnaire
- Patient Family Contact List
- Patient Family Contact List - Spanish
- Patient Demographics
- Patient Demographics - Spanish
In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.
**You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.**
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
To request a Good Faith Estimate for any service, call 1-855-632-6667 . For questions or more information about your right to a Good Faith Estimate, visit the Centers for Medicare & Medicaid Services Website or call 1-800-985-3059 .