The following forms may be required for those enrolling as a new patient, or for existing patients to update information or transfer care.
To complete the PDF forms, you can either print directly or download and save the PDF to your computer..
New Patient Packet (Full packet)
Patient Registration Form & Treatment, Payment & Data Agreement
Annual Health History Questionnaire
Authorization for Request of Protected Health Information (for requesting records from outside provider)
Authorization for Release of Protected Health Information (for releasing records to outside provider or individual)
Request for Amendment in Medical Record
Patient Rights & Responsibilities
Completed forms may be faxed to (508) 487-6298 or emailed to firstname.lastname@example.org.
Please note: If you email a form(s) to Outer Cape Health Services, it will not be encyrpted, and therefore not secure. If you have any questions you may contact the Compliance Department at (508) 905-2800.