Forms

New Patient Forms

If you are a NEW PATIENT, please complete the forms below and return it to your provider’s office prior to your appointment via email (preferred), fax, mail, or in person. If you wish to complete these forms electronically, please sign up for a MyChart account here: /mychart-at-gbmc/. You will receive a notification 7 days prior to your appointment to complete all necessary information.  

• Welcome Packet
• Registration Packet *only required if you did not provide requested information over the phone
• Patient Consent to Treat and Financial Agreement
• Obstetrical Pre-Registration Form – FOR OB PATIENTS ONLY
• READ- Notice of Privacy Practices English | Spanish
• CONSENT- Notice of Privacy Practices
• COVID-19 Informed Consent
• Authorization for Release of Information to a Spokesperson
• Health Care Agent Form – Instructions here

Medicare Patient Forms

If you are a NEW PATIENT WITH MEDICARE as your primary insurance, please complete the forms below and return it to your provider’s office prior to your appointment via email (preferred), fax, mail, or in person. If you wish to complete these forms electronically, please sign up for a MyChart account here: /mychart-at-gbmc/. You will receive a notification 7 days prior to your appointment to complete all necessary information. 

• Welcome Packet
• Registration Packet *only required if you did not provide requested information over the phone
• Patient Consent to Treat and Financial Agreement
• Obstetrical Pre-Registration Form – FOR OB PATIENTS ONLY
• READ- Notice of Privacy Practices English | Spanish
• CONSENT- Notice of Privacy Practices
• COVID-19 Informed Consent
• Authorization for Release of Information to a Spokesperson
• Health Care Agent Form – Instructions here
• Health Assessment Form