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: METAIRIE

Single packet containing all of the patient forms.
Download PDF (2 MB)

Download PDF – Spanish (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

Protected Health Information (PHI) Release Forms

You may request copies of your medical records or request that your medical records be sent to another provider by contacting Automated Filing Systems (AFS) at (225) 296-0237 or release@automatedfilingsystems.com. The authorization for Release of Protected Health Information form will need to be printed, completed, and signed by the patient. Please be sure to select the form for the specific clinic that you visit.