Patient Forms

NEW MEMBER FORMS – CLICK TO DOWNLOAD

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Membership Agreement

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Code of Conduct

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Consent to Unecrypted PHI

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Consent for Ongoing Treatment

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Consent for Telemedicine

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Notice of Privacy Practices

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Medicare Contract (only for patients with Medicare)

OTHER FORMS – CLICK TO DOWNLOAD

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Record Release Form

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Record Request Form

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Membership Termination Form

PATIENT PAYMENT PORTAL

To access our patient payment portal please click here.
Contact

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ADDRESS

3624 North Centrepoint Way, Suite 100
Meridian, ID 83646

Just north of Hobby Lobby.