Forms

Patient Forms

• Authorization to Release Medical Information
• HIPAA Avisio de Practicas de Privacidad Reconocimiento y Consentimiento (Spanish version of HIPAA Privacy Notice)
• Patient Information form
• Informacion Del Paciente (Spanish version of Patient Information Form)
• Privacy Notice (HIPAA Form)

Notice of Privacy Practices

• TPMG Notice of Privacy Practices (Revised September 23, 2024)

Medicare Annual Wellness Visit

• Medicare Annual Wellness Visit Information Guide

Provider Forms

• Consultation Request form (Providers Only)

Note to our patients: The forms listed above are basic forms used by every TPMG office. Please visit the specific office’s webpage to view a complete listing of forms used by them. For your convenience, you may print, complete and bring in the forms at the time of your visit rather than filling out the paperwork in the office.