Forms

Forms

Patient Forms

• Authorization to Release Medical Information
• HIPAA Aviso 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 June 1, 2024)

Medicare Annual Wellness Visit

• Medicare Annual Wellness Visit Information Guide

Physician-Only Forms

• Consultation Request (Physician-Only)

Note to our patients: The forms listed above are standard 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.