Family Health Centers

Information Requirements

At the time of your visit, our receptionist will ask you to complete a patient information form. Since it has a bearing on your health and physical status, we need to know your occupation, age, and other personal information. This information is also used to complete insurance claims forms. You will be asked to sign an authorization for release of medical information and authorization for your insurance company to pay the doctor directly for charges incurred. All information you provide to us is strictly confidential.