Patient Forms

At AccelHealth, we strive to make your relationship with us a convenient as possible. On this page, you will find multiple methods to get the forms that are necessary for us to provide the outstanding, whole family, healthcare you expect and deserve.

The preferred, and most efficient forms submission is with our on-line version listed first. With this method, forms are filled, signed, and submitted, all without requiring the forms to be printed, filled out, and carried to your clinic of choice.

AccelHealth has done extensive testing of the on-line forms, using multiple operating systems (PC, MAC, iPhone (iOS), and Android), with the browsers that come with the above listed systems. If for any reason you have problems filling out and submitting the forms, please follow this link and provide feedback detailing the issue, and we will do our best to address the problem.

In the event your system has problems with the on-line version, we provide links to download the forms. The downloaded forms will then need to be printed, filled out, and presented to the front desk when you arrive for your appointment. The forms would then be scanned into our system.

Required forms:(*) New Patient Registration, Family Size and Household Income, and HIPAA/PHI Authorization Form. Other listed forms are only required if additional assistance is requested. This applies to both the online and downloadable versions.

New Patient Forms (On-Line)

EnglishESPAÑOL
REQUIREDNECESARIO
*New Patient Registration*New Patient Registration
*Family Size and Household Income*Family size and household income
*HIPAA/PHI Authorization Form*HIPAA/PHI Authorization Form
OPTIONALOPCIONAL
Letter of Support for Individuals with no incomeLetter of Support for individuals with no income
Application for Sliding FeeApplication for Sliding Fee

New Patient Forms (Download)

ENGLISHESPAÑOL
REQUIREDNECESARIO
*New Patient-Registration*New Patient-Registration
*Family-Size-Household-Income*Family-Size-Household-Income
*HIPPA-PHI-Authorization-Form*HIPAA-PHI-Authorization-Form
OPTIONALOPCIONAL
Letter-of-Support-FormLetter-of-Support-Form
Sliding-Fee-ApplicationSliding-Fee-Application