Patient Registration Forms:  Please use both pages:

      HIMA_2012_Registration_Form_Page_1_of_2.pdf

      HIMA_2012_Registration_Form_Page_2_of_2.pdf

 

Travel Medicine Visit Forms:  Please use all the forms below:

      Travel_Med_Visit_Page_1_of_2.pdf

      Travel_Med_Visit_Page_2_of_2.pdf

      HIMA_2012_Registration_Form_Page_1_of_2.pdf

Commercial Drivers:  Please use the following form and bring it with your state driver's license to your visit:

      DOT Form.pdf

 

Records Release:  Please use the form below to transfer records to or from our office:

      Pt_Auth_for_Rel_of_Info.pdf