Caring in Community

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Cottage Med

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Patient registration

Click the links below to download patient registration forms in PDF format. Adobe Reader, a free program, is required to view the forms.

Full patient registration packet (510K)
Page 1: Personal Information (61K)
Page 2: Consent to Care (67K)
Page 3: Consent for Release of Information (54K)
Page 4: Patient Medical History (125K)
Page 5: Review of Systems (174K)