Forms

New patient forms

Please make sure you click on each form to view/print and fill out #1 – 11 completely before returning the forms to Bassett Family Practice or Ridgeway Family Health.

icon of pencil and clipboard

  1. New Patient Welcome Letter
  2. Prescribing Notice
  3. MedAssist Information
  4. Patient Demographics
  5. Reduced Fee Application
  6. History Questionnaire
  7. Authorization for Release of Information
  8. Cancellation Notice
  9. Consent to Treat
  10. Patient Portal Guidelines
  11. Notice of Privacy Practices/HIPAA