Patient Forms and Notices
To help make your visit as smooth as possible, please review and complete the forms below before your appointment. You can print them at home and bring them with you, complete and email them to your provider, or fill them out when you arrive.
New Patient Forms
If this is your first visit with us, please complete our New Patient Packet. This includes your medical history, contact information, and consent for treatment. Completing this ahead of time helps us get you seen faster and gives our providers the information they need to give you the best care.
Wellness Exam Form
If you're coming in for an annual wellness or preventive exam, please complete this form ahead of your visit. It covers your current health status, any changes since your last visit, medications, and screening history, so your provider can make the most of your appointment time.
Notice of Privacy Practices
Federal law (HIPAA) requires us to protect the privacy of your health information and to let you know how we may use and share it. Our Notice of Privacy Practices explains your rights regarding your medical records and how we safeguard your personal information. We ask that all patients review this notice and sign an acknowledgment of receipt.
Download Notice of Privacy Practices
Having trouble opening or printing these forms? Contact our office at 405-655-5860 and we'll be happy to help, or fill them out in person when you arrive. Forms can also be submitted via email to kaylee@prairieroseprimarycare.com.