We have placed our new patient forms online for your convenience. We urge you to go ahead and download them, fill them out, and bring them with you to your first appointment. This will assist us in serving you as efficiently as possible and help us to provide you with quality care.
- Health Information Questionnaire - PDF Document
- Consent for Healthcare Messages - PDF Document
- Financial Policy - PDF Document
- Statement of Informed Consent - PDF Document
- Patient Registration Form - PDF Document
- Against Medical Advice - Waiver - PDF Document
- Advance Directives - PDF Document
- Privacy Notice - PDF Document
- Discrimination Notice - PDF Document
- Interpretive Services - PDF Document
- Authorization To Consent To Medical Treatment of a Minor Child - PDF Document
If you are seeing a Summit Pulmonologist, please print and fill out this History & Physical form. This form replaces the Health Information Questionnarie for new Pulmonary patients. Please complete all other New Patient Forms prior to your visit and bring them with you when you vist your Pulmonologist.
Authorization for Medical Disclosure Form
This form is used to authorize Summit Medical Group to release protected information to a person or entity of the beneficiary’s choosing. Please print, complete the form and provide it to the physician’s office where your medical record resides.
- Authorization For Medical Disclosure - PDF Document