All of our forms are PDFs. They can be downloaded, filled out electronically, saved, and then submitted online below through our digital delivery form. Or, printed and filled out by hand.

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

Forms To Download & Fill Out:

Patient Registration Form

Medical Records Form

Sliding Fee Application Form

Dental Medical History Form

Chiropractic Form

Submit Patient Forms

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To make an appointment at any location, or to speak with a Financial Services Specialist please call 1-888-730-2374

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Palms Medical Group is a FTCA Deemed Facility.
This institution is an equal opportunity provider and employer.
This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.
This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).
Notice of Privacy Practices | Patient Bill of Rights