PHS, LLC

Please bring your insurance card and ID card with you for each visit and notify our front desk anytime your insurance coverage changes.
Instructions

New Patients:

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• New Patient Registration Form
• Notice of Privacy Practices
• Financial Policy
• Release of Medical Records
• Authorization to Release Information
• Adult Medical History (For Primary Care Patients)
• Adult Medical History (For Cardiology Patients)
• No Show and Cancellation Policy

Cardiology Forms and Documents:

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Covid-19 Forms & Information:

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• Covid-19 Vaccine Pre-Screening Form
• Covid-19 Vaccine Pre-Screening Form (Page 1 Only)
• Johnson & Johnson Covid-19 Vaccine Information

Pediatrics Forms:

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• Consent for Treatment of Minor Child
• Consent for Treatment in the Absence of Parent
• Pediatric Medical History
• Pediatric Well-Visit Form(Age 3-5)
• Pediatric Well-Visit Form(Age 6-9)
• Pediatric Well-Visit Form(Age 10-12)
• Pediatric Well-Visit Form(Age 13-20)
• Preventative Screen Questionnaire
• PHQ-9 for Teens

Sleep Medicine Forms:

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• Sleep Questionnaire
• Epworth Sleepiness Score
• Stop-Bang Questionnaire

If you are looking for Online Secure Forms please click this: Online Forms

Please note: These documents are in Adobe® PDF format. They require Adobe Reader() to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here!