Patient Forms

Everything you need to get started

Below are links to the forms you may need prior to your initial appointment.
Included here are: New Patient Contract, Health History Form, Notice of Privacy Practices, Acknowledgement of Privacy Practices, and the Medicare Opt-Out Agreement.

Form — Instructions

Form Instructions

We invite you to access any of our forms prior to your next appointment. In this section, you will find all that you need to ensure you have an efficient and high-quality visit.

New Patient — Contract

New Patient Contract

Please download and fill out our new patient form first.

Health History — Form

Health History Form

Second, please download and fill out the Healthy History Form.

Notice of — Privacy Practices

Notice of Privacy Practices

Third, download and review our Notice of Privacy Practices, which outline our promise of privacy and confidentiality of all client information.

Acknowledgement — of Privacy Practices

Acknowledgement of Privacy Practices

This form is required for legal purposes to acknowledge that you have received and read our promise of client information privacy practices.

Medicare Opt-Out — Agreement

Medicare Opt-Out Agreement

Finally, please download and fill out this form if you would prefer to opt-out of any Medicare-related insurance coverage.

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What is DPC?

Direct Primary Care provides for comprehensive access to primary care medical services by means of a transparent, affordable pricing model.

Membership Plans

We have comprehensive primary care medical plans available for a variety of client needs, including single men or women, couples, and family groups.


Want to learn more about how DPC works and the benefits and perks?
Check out our helpful FAQ page!

Request a Free Consultation

Fill out the form below to request a call-back, to schedule a free consultation.  Or you call us directly at the phone number shown here.