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Forms For Patients

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 and 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

Notice of Privacy Practices

Patient Rights & Responsibilities

Completed forms may be faxed to (508) 487-6298 or emailed to ochsrecords@outercape.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.