Patient Forms

Business Forms

DIRECTIONS

Below you will find a number of forms used by Prime Healthcare Providers. If the receptionist mentions that you will need to complete one of the following forms, you can save time by downloading the form(s) from our website and completing the form(s) prior to your visit.

The forms that are available in Adobe (PDF) format. After downloading them, you will need to print to paper and then complete by hand.

PDF FORMAT

Please click on the link below to download the form (Adobe Acrobat Reader is required).

The files below are in Adobe (PDF) format. In case you do not have a PDF viewer installed on your machine, please click on the link below to download the free program from (Adobe Acrobat Reader).

After downloading the form, print it out and fill out the information by hand. Once the form is completed you can either fax it to our office at 713-932-8303) or bring it with you at the time of your visit.

• New Patient Forms
• Registration Forms
• Financial Policies
• Medicare ABN
• Non-Covered Services Agreement
• Building Directions to Office
• Health Questionnaire


• Established Patient Forms
• Registration Update Form
• Today's Presenting Chief Complaint Form
• Change of Insurance Information
• Advanced Directives
• Privacy Notice
• Privacy Notice Statement
• Acknowledgement of Receipt
• Form - Consent to Use & Disclose
• Request for Restrictions
• Financial Policies
• Financial Policies
• Payment Extension Agreement
• Service Agreements
• Medicare ABN
• Non Covered Service Agreement
• Medical Records Transfer
• Records - Going TO another Office
• Medical Record Transfer Fee
• Records - Coming FROM another office
• Instructions
• Understanding your Lab Result
• Stress Test Instuctions and signature form
• Holter Monitor Instructions
• Bone Density Testing Instructions
• Echocardiogram Testing Instuctions
• Ultrasound Testing Instructions

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