Patient Forms

Forms for New Patients:

(If you are not at BHMC patient and need to be seen for a Sports Physical or an Urgent Care Visit ONLY, please scroll to other forms)

Welcome Letter | Brock Hughes

Welcome Letter (for your reference)

Photo By: John Doe
Button
Notice of Privacy | Brock Hughes
Health History Form | Brock Hughes

Health History Form

Photo By: John Doe
Button
Patient Registration Form | Brock Hughes

Patient Registration Form

Photo By: John Doe
Button
Consent to Share Medical Information | Brock Hughes
Acknowledgements and Authorizations Form | Brock Hughes
HIPPA Medical Records Release Form | Brock Hughes
Medication Assistance Program Waiver | Brock Hughes
A close up of a bright green background.

Other Forms:

Urgent Care Form | Brock Hughes
Sports Physical Form | Brock Hughes