Patient Forms

All of our forms are PDFs. They can be downloaded, completed, and then submitted using the below options. NOTE: the Sliding Fee Applications must be printed, completed/signed, and then returned to your Palms Medical Group preferred location.

Before downloading the forms, you may need to get the appropriate PDF AdobeReader® software.

Forms to download and complete:

Medical Records Form

Medical Records Form – Spanish

Sliding Fee Application Form

Sliding Fee Application Form – Spanish

Sliding Fee Application – Haitian-Creole

Dental Medical History Form

Dental Medical History Form – Spanish

Chiropractic Form

Notice of Privacy Practices

Notice of Privacy Practices Spanish

Notice of Privacy Practices – Haitian Creole

Sports Physical Form

Patient Registration & Consent Form

Patient Registration and Consent Form – Haitian Creole