Patient Forms

Thank you for being our valued patient and trusting New West Physicians with your health care needs. We are committed to providing excellent service, every patient, every time and regard it as a privilege to serve you.

Below are various patient forms that you may need throughout your healthcare journey. Select the form you need, download, and print.

If you are a New West Physicians patient making a request for your medical records, please use the following link.

Preventive visits – Informed Billing Decision Form

Preventive visits are an important part of your overall health management plan. Download and fill out this form before your next preventive visit with your doctor.

Forms & Resources

Patient Policies & Procedures

Financial, Prescriptions, test and scheduling information for all patients.

Privacy Practices

This notice describes how medical information about you may be used & disclosed and how you can get access to this information.

Care of a Minor Waiver

Please download, print and complete before bringing it to your first New West Physicians appointment.

Parental pre-authorization for Medical Care

For minors aged 16-18, a pre-authorization form can be submitted if care for these patients is desired without further parental consent.

Pediatric Health Questionnaire

Please complete your child’s health history form below. Bring a copy of your child’s immunizations to their next visit or fill out a release form in the office today.

ASQ Pediatrics Questionnaires

To complete the ASQ Ages & Stages Questionnaires for screening infants and young children for developmental delays or concerns, please click here.

Transfer of Medical Records

This form is needed to facilitate the transfer of medical records from your previous provider to the team at New West Physicians.

Musculoskeletal Injury Questionnaire

This form provides a fact-find for musculoskeletal injuries which will be helpful to our care team upon arrival.

DEXA Bone Density Scan

DEXA Bone Density Scan

Online Medical Records Request

If you are a New West Physicians patient making a request for your medical records, please use the following link.

Endoscopy

EGD Upper Endoscopy Prep Instructions