Patient Forms and Policies

Provided below are forms that may require completion prior to your visit and/or testing. Please download the appropriate form(s) as directed by clicking on the name of the form. This will help save time and may expedite the registration process. Thank you.

General Forms and Policies:

• Patient Information Form
• CCHC Financial Policy
• Consent for Treatment of Minor Child
  
• CCHC Authorization to Not File to Insurance
• Care Everywhere Opt Out

HIPAA and Non-Discrimination Forms and Notices:

• Authorization to Release Health Information
• Authorization to Discuss Information with Others
• CCHC Notice of Privacy Practices
  
• CCHC Non-Discrimination Notice
  
• Acknowledgement of Receipt Notice of Privacy Practices
  
• HIPAA Complaint Form

Specialty Forms and Instructions:

• Sleep Lab Instructions
• Sleep Study Questionnaire
  
• Computed Tomography (CT Scan) Questionnaire
• MRI Screening Form