Forms

We are excited that you are interested in our new practice and look forward to continuing our relationship. In order to move forward, we ask that you print and complete the forms below and bring them with you on your next visit.

New Patients -

Unless instructed otherwise, download the New Patient Packet only, as it includes all of the individual forms in one file. If you have Medicare, also download that form.

New Patient Packet - New Patient Packet to download

Medicare Form - Required only for those with Medicare 

Individual Forms - Download these forms only if you have been instructed to do so.

Records Release - Consent to release your medical records TO Touchstone Internal Medicine 

Demographic Form - Required for internal processing and tells us your demographic and insurance information 

Phone Consent - Required for internal processing and tells us who we can talk with regarding your care 

Patient Agreement - Please initial each statement

Payment Method - Use this form to choose the payment method you prefer

Privacy Practices - Personal health information

Verification - To verify that you read and/or received the Notice of Privacy Practices document

FAQ - Answers to commonly asked questions

MOST - Medical Orders for Scope of Treatment

If you would like Touchstone to release your records to another facility please download and complete the form below.

Release of Medical Information From Touchstone – Consent for Touchstone to release your records to another person or facility

We look forward to spending more time attending to your medical needs. If you have questions regarding the above information, please call or stop by the office and we’ll be happy to help.