Patient Forms

• Authorization to Release Medical Information (Please use this form if you are transferring care to another provider outside of TPMG)
• Autorización para la Divulgación de información Médica
• Notice of Privacy Practices Acknowledgement and Consent (HIPAA Privacy Notice)
• HIPAA Aviso de Practicas de Privacidad Reconocimiento y Consentimiento (Spanish version of HIPAA Privacy Notice)
• Patient Information Form
• Informacion del Paciente (Spanish version of Patient Information Form)
• Imaging Release of Information
• Financial Policy Form
• Política Financiera 

Medicare Annual Wellness Visit

• Medicare Annual Wellness Visit Information Form
• Medicare Wellness Check-Up Form

Note to our patients:  The forms listed above are standard forms used by every TPMG office. Please visit the specific office’s webpage to view a complete listing of forms used by them. For your convenience, you may print, complete, and bring in the forms at the time of your visit rather than filling out the paperwork in the office.