Change of Address or Insurance
To be completed when your address or insurance has changed.
Patient History Form
Provided at visit time to help ensure proper medical history is known.
New Patient Form
To be completed by all new patients.
To be completed when requesting that your medical records be transferred from LPMC to a new practice.
To be completed when requesting that your medical records be transferred to LPMC from your previous practice.
To be completed when requesting health information (written or verbal) be shared with someone other than the patient (18 years or older) or parent/guardian.
To be completed to receive COVID vaccine