Forms and Documents

• Adult Demographic Form
  Please print and complete if you are an ADULT seeing the physician and bring it with you to your appointment.
• Minor Demographic Form
  Please print and complete if the patient seeing the physician is a MINOR, bring it with you to your appointment.
• Patient Health History Form
  Please print and complete, bring with you to your appointment.
• Auto Insurance Information Form
  Please print and fill out if the patient was involved in a motor vehicle accident and will be seeing our physician for related injuries.
• Medical Record Release To Us
  Please fill out for medical information to be released to GBPSA from another physician's office.
• Medical Record Release From Us
  Please fill out for medical information to be released from GBPSA to another physician's office.
• Medical Record Future Release
  Please complete this form for patient records for future appointments (i.e. 3-month follow-up, 6-month follow-up, or 1-year follow-up) and the proper medical record release form as well.
• Liability Insurance Form
  Please print and fill out if the patient was involved in an accident and there is a third party responsible (i.e. Homeowner's or Auto Insurance).
• Worker's Compensation Form
  Please print and bring to your employer and have them fill out form completely and send back to us.