HTFM Patient Portal - Publicforms

Available Forms

*1 New Patients: Consent for Treatment & Payment & Acknowledgements *2 New Patients: Cancellation & No Show Agreement *3 New Patients: Text Messaging *4 New Patients: Patient Financial Responsibility *5 New Patients: Updox Patient Portal *6 New Patients: Telehealth (VideoChat)Consent form *7 New Patients: Alternate Phone/Person *8 New Patients: Address and Insurance form *9 New Patients: Medical Records Request To Us 10) New Patients: Please Read! Thank you! 24) Patients Rights & Responsibilities 27) Telehealth (VideoChat) Consent form 31) Address and Insurance Update form 34) Consent for Payment Plan 35) Medical Records Request From Care Management Request for Medicare CCM Staff Log Patient Satisfaction Survey Prescription Refill Request

10) New Patients: Please Read! Thank you!

Your Registration Forms are now complete. You will receive a text from us confirming completion.

Thank you for helping us stream line contact less registration! If you finished forms 1-9 your registration is complete. You will receive a text from our staff securing your private text line with us asking for a picture of your insurance card and drivers license. After that we will see you at your scheduled date and time! Thank you!

-- Home Towne Family Medicine

* Required field