Wayland Personal Physicians New Patient Forms
If you are a new member of Wayland Personal Physicians and you wish to complete your new patient forms prior to your first appointment, you may download them by clicking on the links below. This will speed up your registration process. You may also choose to fill out these forms at our office on the day of your visit.
- New Patient History Form: This form helps us gather your history so we can get a more complete view of your health.
- Medical Records Release: This form allows us to request your medical records from your past physicians (including our previous practice). This form also permits us to release your medical records to others when this is needed.
- Consent to Discuss Medical Information: This form allows us to discuss your medial information with one or more parties at your discretion.
- Notice of Privacy Practices (HIPAA): Protecting your privacy is of utmost importance to us.
- Acknowledgement of Receipt of Notice of Privacy Practices: This form acknowledges reciept of Notice of Privacy Practices (HIPAA).
- Electronic Communications Agreement: If you prefer to use alternative means of communication such as email or video, we ask you to review and sign this document.
- Provider List - Male: This form identifies any specialists you see or have seen in the past.
- Provider List - Female: This form identifies any specialists you see or have seen in the past.
- Advanced Directives: This form protects your right to refuse medical treatment you do not want, or to request treatment you do want, in the event you lose the ability to make decisions yourself.
If you have any questions about any of these forms, please do not hesitate to contact our office at (508) 358-3300. If you are interested in Wayland Personal Physicians membership, please click here or the button below to schedule a meeting.