Forms

New Patients

In order to view your new patient forms you will need to create a patient portal *NOTE only current patients and family members can create a portal account*. If you are NOT already in our system please call us to schedule an appointment, from there we can send you an invite to create your patient portal account via email. If you are already in our system you can simply CLICK HERE to create your patient portal. Once your patient portal account is set up click on the "My Health" tab to view, complete, and print your new patient forms prior to your appointment.

Patient Information Sharing Consent Form - Premier Family Physicians and Premier Internists Consent to Share Personal Health Information. This is Not a Medical Records Request form, see below for our records request forms.

Click Here For New Pediatric Patient Forms

Medical Records Request Forms

Request That Your Records Be Sent To PFP Use this form to request that medical records be sent from another doctor's office to Premier Family Physicians

Request That Your Records Be Sent From PFP - Use this form to request to have records sent from Premier Family Physicians to another Doctor/Facility, or to request a copy for yourself

Patients and third party requestors are now able to submit a request online using Healthmark's secure website.

Simply click here to create an account and submit your request. This service is currently only for requestors that want Premier Family Physicians to release information.

Motor Vehicle Accident Forms (MVA)

NOTE: WE WILL SEE MOTOR VEHICLE ACCIDENT VISITS. WE WILL NO LONGER BILL WITH THIRD PARTY INSURANCES OR ATTORNEYS. WE ACCEPT PERSONAL INJURY PLANS AND HEALTH INSURANCE PLANS.

Go to top