Family Medicine Forms & Patient Handouts

Listed below are common forms and handouts used by the Department of Family Medicine.

Forms  |  Handouts

Forms

• Medical History Forms
  • Adult Medical History Form (.pdf)
  • Pediatric Family History Form (.pdf)
• Advanced Health Care Directive (AHCD)
• English (.pdf)
• Spanish (.pdf)
• Personal Medical Records
  • Request for Release of Medical Records, $15 fee
  • Request for Access to Medical Records, $15 fee

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Handouts

• Fall and Accident Prevention
• Vaccines & Immunizations, Centers for Disease Control and Prevention (CDC)

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