Patient Forms

• Authorization to Release Medical Information (Please use this form if you are transferring care to another provider outside of TPMG)
• 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)
• Privacy Notice (HIPAA Form)
• Imaging Release of Information
• Financial Policy

Notice of Privacy Practices

• TPMG Notice of Privacy Practices  (Revised April, 1, 2022)
• TPMG Aviso de Privacidad Practicas (Revised May 18, 2021)
• TPMG Notice of Privacy Practices Enlarged Version (Revised June 1, 2015)

Medicare Annual Wellness Visit

• Medicare Annual Wellness Visit Information Guide
• Medicare Annual Wellness Visit 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.