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)
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
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.
ALGIERS LOCATION PHI release
Download PDF (226 KB)
NAPOLEON LOCATION PHI release
Authorization for the Release of Protected Health Information
Download PDF (226 KB)
North Broad LOCATION PHI release
Authorization for the Release of Protected Health Information
Download PDF (213 KB)
O'NEAL LOCATION PHI release
Download PDF (226 KB)
perkins LOCATION PHI release
Authorization for the Release of Protected Health Information
Download PDF (226 KB)
slidell LOCATION PHI release
Authorization for the Release of Protected Health Information
Download PDF (226 KB)
WESTWEGO LOCATION PHI release
Download PDF (226 KB)