Patient Information Forms

Patient Information Forms

New patients will be asked to complete the following forms at their first appointment. If you would like to save time at your first appointment, feel free to fill them out at home and bring them to your first visit with us.

• New Patient Information Form (PDF)
• Medical Records Release (PDF)
• Jericho Road HIPAA Consent Form (PDF)

Additional Patient Policies

Please also review the following Jericho Road policies:

• No Show Policy (PDF)
• Controlled Substance Policy (PDF)
• Notice of Privacy Practices (PDF)
• Treatment, Payment, and Healthcare Operations (PDF)

Patient Resources