New patient paperwork

Authorization for Release of PHI
This form requests an inspection or copy of protected health information about a patient. This form was last updated in July 2020.

 

Access to PHI

Access to PHI (English)

Access to PHI (Spanish)

Access to PHI (Creole)

New Patient Form

New Patient Form (English) 

General Consent Form

General Consent Form (English)

General Consent Form (Spanish)

General Consent Form (Creole)

 

HIPAA Privacy Authorization Form

HIPAA Privacy Authorization Form (English)

HIPAA Privacy Authorization Form (Spanish)

HIPAA Privacy Authorization Form (Creole)

Patient Demographic Form

Patient Demographic Form (English)

Patient Demographic Form (Spanish)

Patient Demographic Form (Creole)

 

Notice of Privacy Practices

Notice of Privacy Practices (English)

Notice of Privacy Practices (Spanish)

Center Privacy Notice

Center Privacy Notice (English)

Center Privacy Notice (Spanish)

Center Privacy Notice (Creole)

You belong at CenterWell

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Formerly known as Partners in Primary Care and Family Physicians Group, our new name CenterWell reflects our passion for improving the lives of seniors.  Our team is here and ready to help answer any questions you may have.