Patient Forms

The following information is designed to help patients prepare for their appointments.

To request a copy of your medical records from a non-Family Healthcare Associates provider, please print and complete the following form. (This form will authorize FHCA to receive your records from a non-FHCA provider.)

patient-form
Authorization to Release Medical Records to FHCA

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Authorization to Release Medical Records from FHCA

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Submit your completed form to the location where you received care.

Other Forms

Authorization to Consent to treatment of a Minor

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