Patient Forms

Below you will find a variety of forms, both to help you communicate with us as well as provide the information we need to serve you most efficiently.You may view the forms online or you may just print them out and complete them on your own later. Please fax the completed forms and/or bring them with you to your appointment.

Medical Consent Form

New Patient Registration Form

Authorization to Release Medical Information Form

Patient Responsibility Form

Consent for Treatment Form

Patient Health Questionnaire Form

Please complete and bring these forms with you to your appointment if you:

  • Are a new patient OR
  • If any of your personal or insurance information has changed since you were last here.

Accurate and current information is critical if you are requesting our service either in person, by fax, or by phone.

It will save both you and us time getting your information ready before we can provide you service.


Family Health & Wellness Center is a friendly and professional practice offering a full range of family medicine. From your first visit, to extensive procedures utilizing the latest in medical techniques, we are committed to staying current with the continuing advances in medical science. Dr. Edmond and his staff are highly trained and focused on helping all patients reach a higher level of overall health.

2018 Family Health & Wellness - All Rights Reserved