New Patient Forms

Thank you for choosing Beckford Medical Center.

As a new patient, we will need to obtain important demographic and insurance information from you when you arrive at your first appointment. Be sure to bring a photo ID and a current insurance card with all your clinic visits.

To assist us with your registration process, we encourage you to download, print, and complete the forms below.

New Patient Forms

New Patient Information & Registration Form
This form outlines your personal data and insurance information.

New Patient Health & Medical History Form
This form outlines your health and medical information, and any other healthcare history.

New Patient Consent to Treat & Privacy Practice
This form allows our practice to provide you appropriate evaluation, treatment, and care.

Privacy Forms

Request for Medical Records Release
This form is used to request transfer of your records from other providers.

Federal HIPAA Privacy Authorization Form
This form is used to allow others access to certain parts, or all, of your PHI.

Notice of Privacy Practices
Our privacy policy document describes how your medical information may be used, disclosed, or accessed. We will provide you this notice at the time you check in for your appointment.