Four Corners Health Care, Inc.
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Save Time at Your Next Appointment!

If you would like to avoid having to complete forms at the time of your appointment, please consider printing and filling out the forms below to bring along with you, or you may mail them to us ahead of time.

New Patient Information Forms
(Please Note: One set is for adults and one is for children)
adult_new_patient_forms_.pdf
File Size: 1275 kb
File Type: pdf
Download File

child_new_patient_forms.pdf
File Size: 751 kb
File Type: pdf
Download File


Notice of Privacy Practices Form
This form is for you to read and keep—nothing to fill out. However, you are asked to sign and date the bottom of the Registration form that indicates you have been provided with a copy of our Notice of Privacy Practices form.
Notice of Privacy Practices Form
File Size: 18 kb
File Type: pdf
Download File


Protected Health Information (PHI) Form
To expedite getting medical records from previous providers, complete the following release form (Authorization for Uses & Disclosures of Protected Health Information form) below for records and either drop it off at our office or mail it to us. We will make every effort to obtain and review records before your visit. Please note: we only need the practice name, street name (if you know it), city and state on the form. We can obtain the complete address, phone number and fax number.
Protected Health Information (PHI) Form
File Size: 24 kb
File Type: pdf
Download File

​Disclaimer: This website is not a substitute for medical advice or treatment for specific medical conditions, and is not intended to take the place of the advice and recommendations of a personal health care provider.

Privacy Policies and Terms of Use

FCHC Privacy Policies
File Size: 241 kb
File Type: pdf
Download File

FCHC Terms of Use
File Size: 174 kb
File Type: pdf
Download File

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  • Home
  • About Us
  • Forms
  • What's New
  • Articles
  • Adoption Care
  • Contact