New
Patients
If
you are a new Summit patient, please print our New Patient
Forms*. These are the forms located below the New
Patient Forms* heading. Please complete the forms prior
to your visit and bring them with you when you visit your physician.
This will assist us in serving you as efficiently as possible
and help us to provide you with quality care.
If
you are seeing a Summit Pulmonologist, please print the History
& Physical form listed below Statcare
Pulmonary Consultants*. This form will replace the Health
Information Questionnarie located under New Patient Forms. Please
complete all other New Patient Forms prior to your visit and bring
them with you when you vist your Pulmonologist.
Thank You
New Patient Forms*
Please
click on and print the following forms:
Health
Information Questionnaire (pdf)
Summit
Medical Group Patient Registration Form (pdf)
Patient
Consent Form (pdf)
Consent
for Healthcare Messages (pdf)
Medical
Disclosure Form (pdf)
Financial
Policy (pdf)
Statcare
Pulmonary Consultants*
Please
click on and print the following form in addition to the
New Patient Forms listed above. Please note, this form will replace
the New Patient Form - Health Information Questionnaire:
History
and Physical Form (pdf)
Established
Patients
If
you are an established Summit patient, please print our
Established Patient Forms*. These are the forms located
below the Established Patient Forms* heading.
Please complete the forms prior to your visit and bring them with
you when you visit your physician. This will assist us in serving
you as efficiently as possible and help us to provide you with
quality care.
Established
Patient Forms*
Please
click on and print the following forms:
Medical
Home Consent Form (pdf)
