New Patient Forms
Locally Owned | Over 100 Years of Experience | Family Oriented
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Locally Owned
Over 100 Years of Experience
Family Oriented
Hours:
This is a placeholder for the Yext Knolwedge Tags. This message will not appear on the live site, but only within the editor. The Yext Knowledge Tags are successfully installed and will be added to the website.
Download Adult and Child Patient Forms and More
Please print and fill out all necessary forms before your scheduled appointment at Family Practice Associates. This will help to decrease your wait time, as well as allow you ample time to complete all insurance and previous health information.
To download forms, you will need to have Adobe Reader installed. Click on each description to download the form.
All new patients, please print and fill out all adult or child forms marked with the ** and bring with you to your appointment. Call
us to learn more.
Adult New Patient Forms
- **Patient Registration form also should be filled out by all patients who haven't been to our clinic in the past year, or patients that need to update their name, insurance, address, or other information
- **History and Physical form -- adults
- **Privacy Authorization form should you need to change who can access your medical information, please print and bring this form
Child New Patient Forms for Anyone Under 18
- **Minor Patient Registration form
- **History and Physical form -- children
- **Privacy Authorization form (should you need to change who can access your child's medical information, please print and bring this form)
- **Minor Patient Consent for Treatment form Effective 5/1/16, all minor patients must have this form signed by a parent/legal guardian to come to an appointment alone or for someone other than a parent to authorize treatment.
- School Physical Form This form must be filled out and signed by a parent prior to school physical appointments!
Save Time at the Clinic by Filling Out Our Forms in Advance
Call us to learn more.
(501) 778-0934
(501) 778-0934
Download Adult and Child Patient Forms and More
Please print and fill out all necessary forms before your scheduled appointment at Family Practice Associates. This will help to decrease your wait time, as well as allow you ample time to complete all insurance and previous health information.
To download forms, you will need to have Adobe Reader installed. Click on each description to download the form.
All new patients, please print and fill out all adult or child forms marked with the ** and bring with you to your appointment. Call
us to learn more.
Adult New Patient Forms
- **Patient Registration form also should be filled out by all patients who haven't been to our clinic in the past year, or patients that need to update their name, insurance, address, or other information
- **History and Physical form -- adults
- **Privacy Authorization form should you need to change who can access your medical information, please print and bring this form
Child New Patient Forms for Anyone Under 18
- **Minor Patient Registration form
- **History and Physical form -- children
- **Privacy Authorization form (should you need to change who can access your child's medical information, please print and bring this form)
- **Minor Patient Consent for Treatment form Effective 5/1/16, all minor patients must have this form signed by a parent/legal guardian to come to an appointment alone or for someone other than a parent to authorize treatment.
- School Physical Form This form must be filled out and signed by a parent prior to school physical appointments!
Save Time at the Clinic by Filling Out Our Forms in Advance
Call us to learn more.
(501) 778-0934
(501) 778-0934
They have always been good to me over the years. Dr. Watson and his nurse (Maranda) are wonderful.
- Sylvia Gibbs
Learn More About
Family Practice Associates
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