PCHP Policies and Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

To view the forms listed below, you will need Adobe Acrobat Reader. You may download the Adobe Acrobat Reader for free at www.adobe.com or click the button provided. Please bring your completed forms with you to our office at the time of your visit.

Adults

Downloadable Forms:

Adult Health History

Authorization to Release Medical Information

Authorization to Request Info from Elsewhere

Good Faith Estimate

Notice of Privacy Practices

Notice of Privacy Practices Consent Form

Registration Form

Financial Policy:

PCHP Financial Policy

Pediatrics & Adolescents

Downloadable Forms:

Pediatric Health History

Adolescent Health History

Authorization to Release Medical Information

Authorization to Request Info from Elsewhere

Good Faith Estimate

Notice of Privacy Practices

Notice of Privacy Practices Consent Form

Registration Form

Financial Policy:

PCHP Financial Policy

Welcome to YOUR MEDICAL HOME

Primary Care Health Partners (PCHP) is a network of medical offices with practitioners in family medicine, internal medicine, and pediatrics. With locations in Vermont and upstate New York, we provide high-quality, personalized care in many communities.

Notice of Nondiscrimination:
PCHP complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Download notice form