Package of our 46 most popular medical forms for general clinic use. These are Word documents, so you can personalize and make changes to them all you want. (See list here.)

HIPAA Form (General Form)

Medical History and Examination Form (our most popular medical form!) –here is a sample PDF

Medical Chart Form (Progress Notes for Clinic Use)

Phone Call Record & Follow-up Progress Notes Form

Patient Sign In and Physician Notes (1 page)

Pain Questionnaire Intake Form (2 pages)

Certificate for Return to Work

Medical Exam Form (for chart)

School Sports Participation – Physician’s Sign-off Form

Standard Patient Information Form

Patient Consent Form (see more below: MW 22A-C)

Billing Overview Statement

Consent to Treat a Minor

HIPAA Policy Overview

Permission to Release Information

Privacy Practices

Counseling Goals & History Form $12.99 (4 pages)

Medical Directive Form (Power of Attorney)

Authorization to Disclose Medical Information Form

Authorization to Release Medical Records Form (for use by individual to a clinic or hospital, or for use by a clinic)

Chart Record Form (Medical History)

Request to Review Medical Records

Living Will

Notice of Privacy Policy

Patient Registration Form (see sample PDF here)

NOTICE OF PRIVACY, CONSENT, AND HIPAA (Patient Signs – 1 page)

Patient Consent for Care

Consent for Medical/Surgical Care/Emergency Treatment for Child

Patient Consent for Disclosure of Protected Health Information (PDF) (new requirement for HIPAA compliance)

Records Transfer Consent Form

Minor Consent to Treatment

Treatment of Minors Policy

State of Alaska Consent for HIV Testing (PDF)

Standard Medical Invoice (1 page)

Orthopedic Appointment Codes Form (1 page)

HIPAA Business Associate Agreement

Annual Health Update Form

Immunization History Form

Vaccine Consent Form (Vaccination Consent Form) (1 page)

Emergency Consent for Emergency Treatment (Child)

Emergency Information for Children with Special Needs

$7.99

Annual Safety Performance Appraisal

$7.99

Checklist for Selection of New Employees

Incident Report Form

Safety Meeting Attendance Form

Workers Compensation Case Notes

Health Insurance Claim Form (CMS) (complete form; does not print to preprinted forms)

UB-92 MEDICARE UNIFORM INSTITUTIONAL PROVIDER BILL

$12.99

For all CMS forms, please go to our CMS pages by clicking here.

Drill Site Safety Inspection

Drilling Equipment Inspection

Pre-Shift Drill Rig and Site Inspection

Pre-Shift Vehicle Inspection

Shop Safety Inspection Form

Medical History and Examination Form (our most popular medical form!)

Annual Competency Assessment – send PDF of the form you need for an estimate

Certificate of Child Health Examination (simple form for day cares and preschools)

Certificate of Child Health Examination (Illinois form –see link here)

Checklist for Competency Evaluation

Driver Examination Form

High School Pre-Participation Health Examination

Pre-Employment Medical Assessment

Restricted Duties Assessment

Medical History and Examination Form (our most popular medical form!)

Adolescent Medical History Form

Adolescent Medical History (Parent-Guardian) Form

Adult History – Psychiatric Clinic

Medical History Form – Gynecological/Women’s Concerns

Child & Adolescent History – Psychiatric Clinic

Medical History and Examination Form

Medical History Form – Child

Patient Information – Psychiatric Clinic

Pediatric Health History Form

Personal Health & Medical Record

Standard Medical History and Examination (federal form)

Determine Your Nutritional Health

Diabetes Questionnaire

Pre-Employment Back Strength and Flexibility – not currently available; please send sample or pdf for us to make in Word

Authorization for Release of Health Information (HIPAA)

Advance Health Care Directive

Medical Treatment Referral

Request for Access to Medical Records

Request for Release of Information

Travel Medical Form

Travel Release Form for Schools

Return to Work Forms

Certificate to Return to Work

Transitional Return to Work Agreement

Adolescent Medical History Form

Adolescent Medical History (Parent-Guardian) Form

Child & Adolescent History – Psychiatric Clinic

School District Activities Form (School Physicals)

School Physical Information Handout

Schools Sports & Activities Registration Form

Pediatric Health History Form

Request for Access to Medical Records – Adolescent Form (request by parent or guardian)

Detailed Adolescent or Child Medical History Form (3 pages)

Adolescent Medical History Form – Addendum – Questions for Parent or Guardian

Certificate of Child Health Form

Travel Release Form for Schools

Medical Examination Report for Commercial Driver Fitness Determination (9 pages) – fromU.S. Department of Transportation, includes instructions and certificate

Return to Work Form

Occupational Services Request Form

Authorization Form

Emergency Follow-up Instruction Sheet for Patients Treated for Work-related Injury or Illness

Privacy Policy

Medical History Form

Financial Policy

Private Communication Request Form

Patient Information Form

Travel Medicine Form

Medical Treatment Authorization – Occupational Medicine

Patient Intake Form

Authorization form for medical and surgical treatment from patient to physician.

Authorization for medical and surgical treatment on behalf of a relative.

Consent to release medical records.

Power of Attorney to give another person decision making power to authorize all medical and surgical procedures.

Medical Examiners Certificate for Commercial Driver Fitness Determination

Info. Request Form

OSHA Respirator Annual Fit Test Form (Qualitative Fit Test (QLFT) Form)

Accident investigation Form – Includes 3 forms in one document: Employee’s Report of Injury and Supervisor’s Accident Investigation and Accident Witness Statement

Blood Borne Pathogen Incident Report Form

Annual Health Update Form – 1 page, mainly regarding vaccinations

Annual Health Update Form – 1 page, for K-12, list of current illnesses and medications

Immunization History Form

Vaccine Consent Form (Vaccination Consent Form) (1 page)

For more occupational forms, just email us with the form you need.

General Surgery Consent Form (General)

Child and Adolescent Surgery Consent Form

Consent Form for Plastic Surgery – Generic

Emergency Room Consent Form – Generic

Chart for 6-week Follow-up

Six-Week Follow-up Primary Total Joint Arthroplasty (TJA)

Progress Notes – 1 page

Progress Notes – 2 page

Oxford Hip Score

Chart for Pre-op cardiovascular (CV)

12-Week Follow-up Primary Total Joint Arthroplasty (TJA)

and many more to come; just send us your pdf or scan or title of the form you want, and we will let you know if we can make it in Word!

Cardiavascular and thoracic Surgery Clinic Forms PACKAGE: Includes: Patient Questionnaire (3 pages), Follow-up, Case History (2 pages), Patient Intake Form, Authorization for Disclosure and Transfer of Medical Information & Records, and Insurace Assignment/Benefits and Release Form (9 pages total)

Employee Manual 50 pages, general employee manual; easily search and replace with your clinic’s name and make changes as needed $99

Proposal Template Formatted in Word with headers, footers, automatic contents, page numbers, section breaks, section headings, reference page, appendix, covers, and more. Instructions included for writing your proposal.

Report Template Formatted in Word with headers, footers, automatic contents, page numbers, section breaks, section headings, reference page, appendix, covers, and more. Instructions included for writing your report.

Statement of Qualifications (SOQ) Template for Medical Clinics Formatted in Word with headers, footers, automatic contents, page numbers, section breaks, section headings, covers, and more. Instructions included for writing your SOQ.

OTHER FORMS

Nursing Clinical Progress Note

OPTHAMOLOGIST FORMS

Eye Chart with Graphics; 1 page

Just email us with your request!

FOOT CLINIC OR PODIATRIST FORMS

Foot Clinic Billing Codes Form

Foot Clinic Patient History and Exam Form (2 pages including pictures)

Foot Clinic Patient Fill-in Form – 1 page – in Spanish