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Proud to be a part of Privia Medical Group
Patient Forms
Patient Forms
Click on the buttons below to download our new patient forms.
ADHD Forms
Anxiety Forms
Depression Forms
Patient Forms
- Preferred Contacts Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos.
- Language Services https://www.priviahealth.com/notice-nondiscrimination/
- Financial Policy This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
- Authorization and Consent for Treatment Form All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento.
- Authorization Release Form Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
- Notice of Privacy Practices Notice of Privacy Practices
Sports Participation Forms
- BPS COVID Waiver
- FHSAA Participation Physical EL2 Form - Sports Participation Form
- FHSAA Consent Form - Sports Participation Forms
- Brevard Public School Cardiology Report Clearance Form - Sports Participation Form