Download Your Medical Forms
For your convenience, you can find the following forms here, downloadable, with instructions:

Patient Registration

This form enables us to enter you into our records as our patient. In it you provide basic information about yourself (name, contact information, etc.), including your payment information. Download form

Medical History
In order to provide you with the best care, it is important that we have as much relevant information as possible about such matters as your medical history, medical issues that may run in your family, prescription and non-prescription medications you may be taking, and symptoms or medical concerns you might have. This form is for you to provide us with this information. Download form

Advanced Directive and
Advocate Designation
You have the right to request medical treatment you want and refuse medical treatment you do not want. In order that you be best prepared to exercise this right in a situation where you are unable to make or communicate your decisions, this form allows you to designate the person you wish to make those decisions on your behalf. The form allows you to include whatever specific instructions you wish; anything that comes up that is not covered in your instructions will be decided by the person you have designated as your patient advocate. Included is an optional form for organ donation. Download form

Patient Provider Agreement
Health care is best understood as a partnership between the patient and the health care provider. In order to best serve the patient’s health and well-being, both the patient and the provider have important obligations. This form explains those obligations that enable you and your doctor to effectively communicate, and arrive at and implement well-informed decisions that fit your values and preferences.
Download form

Medical Record Request and Leaving Our Care

You have the right to your medical records. We will provide you with all medical records we have on you as our patient upon request, including but not limited to if you are leaving our care and transferring to a different primary care provider. This form explains our policies concerning release of your medical records to you or to another party whom you designate. Download form

Privacy and Security of
Health Care Information
The HIPAA law guarantees that the privacy and security of your health information is safeguarded. This form directs you to where you can learn more about your HIPAA rights, including how your health information may and may not legally be used and disclosed, and how you can get access to your health information. Download form

Informed Consent for
Feminizing Therapy
Estrogen or androgen antagonists may be used for persons in the male-to-female spectrum who wish to reduce gender dysphoria and facilitate a more feminine gender presentation. Before you receive feminizing therapy, it is important that you fully understand the treatment and its implications and risks. This form provides a summary of the treatment for you to review, and to consent to if you choose to receive the treatment. Download form

Informed Consent for
Masculinizing Therapy
Testosterone may be used for persons in the male-to-female spectrum who wish to reduce gender dysphoria and facilitate a more masculine gender presentation. Before you receive masculinizing therapy, it is important that you fully understand the treatment and its implications and risks. This form provides a summary of the treatment for you to review, and to consent to if you choose to receive the treatment. Download form