Patient Forms
Are you a new patient with us? Do you need to request or release your medical records? Save time at your appointment – print and fill out the forms below before you come in.
Please note: We are not able to accept forms through this website or through email.
- Authorization for the Institute for Family Health to release medical information: HIPAA Release to the Institute – English | Spanish
- Request for medical information to be sent to the Institute for Family Health: HIPAA Release from the Institute – English | Spanish
- Record Request: DOH 5032 Medical Records Release Form – English | Spanish
- Patient Welcome Form – English | Spanish
- Patient Consent and Notification – English | Spanish
MyChart / MiRecord
The Institute for Family Health
Si ya es paciente, puede usar MiRecord para enviar mensajes a su equipo de atención, ver los resultados de las pruebas, programar citas y más.
Ir a MiRecord
Affordable Care
No one is turned away
The Institute for Family Health accepts Medicaid, Medicare, and most insurance plans. If you do not have health insurance, we can help. Ask us about how to apply for our sliding-fee discount program. You may be eligible based only on income and family size.