Patient Forms
Your Time is Valuable
Forms for your visit to Vibrant Health Family Clinics can be downloaded and completed prior to your appointment. The forms are provided in PDF format, which require Acrobat® Reader.
Patients Over 18 Years
- General Consent Form
- New Patient Information
- Health History Assessment for Adults
- Depression & Alcohol Assessment
- Authorization for Use & Disclosure of Patient Health Information
- Asthma Control Test (12 and older)
New Patients Ages 0 – 10 Years
- Autism Screening for 15 – 18 month olds
- New Pediatric Patient Health History – New Patients birth – 10 years
- General Consent Form
- New Patient Information
- Sports Physical Evaluation
- Authorization for Use & Disclosure of Patient Health Information
- Medical Authorization Form
- Asthma Control Test (Age 4-11)
- Asthma Control Test (12 and older)
Patients Ages 11 – 14 Years
- Health History Assessment for Ages 11 – 14
- Health History Assessment for Parents of Adolescents
- General Consent Form
- New Patient Information
- Letter to parents of patients ages 11 – 14
- Sports Physical Evaluation
- Authorization for Use & Disclosure of Patient Health Information
- Medical Authorization Form
- Asthma Control Test (Age 4-11)
- Asthma Control Test (12 and older)
Patient Ages 15 – 18 Years
- Health History Assessment for Parents of Adolescents
- Health History Assessment for Ages 15-18
- General Consent Form
- New Patient Information
- Sports Physical Evaluation
- Authorization for Use & Disclosure of Patient Health Information
- Medical Authorization Form
- Asthma Control Test (12 and older)