PATIENT FORMS
Complete Packet – NEW PATIENTS
NEW PATIENT: Baton Rouge – O'NEAL
Single packet containing all of the patient forms.
Download PDF (2.3 MB)
NEW PATIENT: Baton Rouge – PERKINS
Single packet containing all of the patient forms.
Download PDF (2.3 MB)
NEW PATIENT: ALGIERS
Single packet containing all of the patient forms.
Download PDF (2.3 MB)
NEW PATIENT: HAMMOND
Single packet containing all of the patient forms.
Download PDF (1.0 MB)
NEW PATIENT: HOUMA
Single packet containing all of the patient forms.
Download PDF (431 KB)
NEW PATIENT: LAFAYETTE
Single packet containing all of the patient forms.
Download PDF (734 KB)
NEW PATIENT: METAIRIE
Single packet containing all of the patient forms.
Download PDF (2 MB)
NEW PATIENT: New Orleans – Napoleon
Single packet containing all of the patient forms.
Download PDF (3.0 MB)
NEW PATIENT: New Orleans – North Broad
Single packet containing all of the patient forms.
Download PDF (1.9 MB)
NEW PATIENT: SLIDELL
Single packet containing all of the patient forms.
Download PDF (2.3 MB)
NEW PATIENT: WESTWEGO
Single packet containing all of the patient forms.
Download PDF (2.3 MB)
Individual forms
patient information form
Responsibility for Payment and Receipt of HIPAA Notice
Designation of personal representative
Consent for Treatment PCP
Patient Instructions for Medical Record Requests
Requesting medical records can be confusing. HealthMark Group is here to help! As our release of information partner, HealthMark is here to streamline the process and get you your records faster and more efficiently.
How do you request records?
Requests may be submitted electronically through HealthMark’s Request Manager at https://requestmanager.healthmark-group.com. Once logged in, select “Submit Request” from the menu options and enter all required fields to provide an authorization directly to HealthMark. Your medical record request will be processed, and a notification will be sent via mail or email once complete and available for download.
How long does it take to process your requests?
Your record requests are generally processed within 8 business hours. What does that mean? One or two business days after you submit your request, your records will be delivered electronically – right to your inbox.
Do you have to remember another username and password?
Nope! HealthMark’s Request Manager does not require usernames or passwords for logging in. Simple email verification and secure links do the trick – getting you your records quickly, efficiently and securely – no password required.
Any questions?
Feel free to log in to Request Manager for status updates or to chat with support. If you have any urgent questions, you may always contact HealthMark at 800-659-4035 or status@healthmark-group.com.
