Forms

Medical Record Release (Workers Comp)

Medical Record Release (Workers Comp)

Allows EFH to obtain medical Information in the event of Workers Compensation filing

Medical Record Release (MV Accident)

Medical Record Release (MV Accident)

Authorization for medical record release in the event of a motor vehicle accident

Medical Record Release (From EFH)

Medical Record Release (From EFH)

Allows Evergreen Family Health to send medical information from your record to a third party such as an employer, insurance company, or other health care provider.

Medical Record Release (To EFH)

Medical Record Release (To EFH)

Allows Evergreen Family Health to obtain medical Information from another medical office or other source

Adult Health Database Update

Adult Health Database Update

For follow-up or annual “PHYSICAL”

Adult Health Database

Adult Health Database

Form for initial health exam – “Complete Physical”

Initial Visit Questionnaire

Initial Visit Questionnaire

For NEW PATIENTS – If reason for visit is not for a physical.

Appointment Request

Appointment Request

An online form used to quickly schedule an appointment