This notice describes how medical information about you may be used and disclosed and how you can
get access to this information. Please review it carefully.
If you are new to Capital Medical Clinic, please follow the links below to print a New Patient History Form and a New Patient Registration Form. To minimize your waiting time, please fill out the complete forms and bring them to your appointment.
(This form is a “fillable” PDF, meaning you can type your information into the form and then print and sign it to bring to your appointment. If you choose to hand write the information, you can simply print this as a blank form.)
New Patient Registration Form >
(This form is a “fillable” PDF, meaning you can type your information into the form and then print and sign it to bring to your appointment. If you choose to hand write the information, you can simply print this as a blank form.)
Financial and Insurance Policy >
Print this form out to bring into your appointment if you have not filled it out in more than a year, or if you are a new patient to our practice.
Annual Physical Acknowledgement >
Print this form out to bring into your appointment if you are a new patient to our practice.
If you need your records from Capital Medical Clinic sent to another physician, please save and then fill out the first form and submit it to us via fax or your patient portal.
Capital Medical Clinic Medical Records Release >
(This form is a “fillable” PDF, meaning you can type your information into the form and then print and sign it to bring to your appointment. If you choose to hand write the information, you can simply print this as a blank form.)
If you want to send us your records from another physician, see below:
Record Release to Capital Medical Clinic from a Previous Doctor >
Please print out the form to fill out. Send completed form to your previous doctor’s office.