Kidney Care Physicians LLC

Patient Forms

Please click on the links provided below to open a PDF formatted version of the form you need to fill out.  Print the form, fill out in blue or black ink, and return to the front office.

Kidney Care Physicians LLC’s “Notice of Privacy Practices

Consent Forms

    Acknowledgement and Consent

    This form is verification that you have viewed or have received a copy of Kidney Care Physicians LLC’s “Notice of Privacy Practices”.
     

    HIE Consent Form

    This form allows Kidney Care Physicians LLC to receive your information in an electronic format from other providers in your care.


    Consent to Release Records

     Please use this form when requesting your Protected Health Information to be copied and send to you or another provider in your care.

Policy Forms        

Financial Policy

This form explains Kidney Care Physicians LLC’s patient financial policy which must be signed prior to your first visit.

Missed of Late Appointment Policy

This form explains Kidney Care Physicians LLC’s missed appointment policy which must be signed prior to your first visit.

           

New Patient to Kidney Care Physicians Please Fill Out One of the Following Packets

          New Patient Packet

    This packet of forms are to be filled out prior to your first visit with Kidney Care Physicians LLC.

    Hospital Follow-up Packet

    This packet of forms are to be filled out prior to your first visit after seeing one of Kidney Care Physicians LLC’s providers in the hospital.
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