Information

Welcome to the 716 Health Medical forms page. Here you can access all the necessary patient intake forms required for your appointment. Please ensure you print and complete these forms before arriving for your appointment.

Accessing your forms

New patients, please download and complete the "Authorization For Release of Health Information Pursuant to HIPAA" and the "PHQ-9" form. Completing these forms ahead of time will help expedite your check-in process and allow you to make the most of your consultation time.

Common questions

The most common issue people face is not knowing where to find the right forms, how to fill them out correctly, or when they need to be completed — especially for a first-time appointment.

How 716 Health Medical helps

We make it clear and simple. All necessary forms are available online or at the office. We let patients know exactly what they need to bring and when to complete the forms (preferably before their visit). If there are questions, our team is just a quick phone call away to help guide them through the process. By reducing confusion and stress around paperwork, we help first-time patients feel more prepared and confident before their appointment.

Authorization For Release of Health Information Pursuant to HIPAA

Authorization for Release of Health Information (HIPAA)

This form allows you to authorize 716 Health Medical to share your protected health information (PHI) with designated individuals or organizations, such as specialists, other healthcare providers, insurance companies, or family members.

Completing this authorization is important when you want us to:

  • Send your medical records to another doctor or facility

  • Allow a family member or caregiver to receive updates about your health

  • Share information with insurance providers for billing or claims purposes

Please fill out the form accurately and legibly to avoid any delays in processing your request. The information you provide ensures that your health data is shared securely and only with those you specifically authorize, in compliance with HIPAA regulations designed to protect your privacy.

PHQ-9 form

Download the PHQ9 form here. Please complete all sections accurately and legibly to ensure we have the necessary information for your appointment.

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