PHS, LLC

Please bring your insurance card and ID card with you for each visit and notify our front desk anytime your insurance coverage changes.
If you are looking for Cardiology or Pediatrics Instructions please click this link: Instructions

New Patients:

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• New Patient Registration Form
• Notice of Privacy Practices
• Financial Policy
• Release of Medical Records
• Authorization to Release Information
• Adult Medical History (For Primary Care Patients)
• Adult Medical History (For Cardiology Patients)

Cardiology Forms:

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• Referral Form

Covid-19 Forms & Information:

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• Covid-19 Vaccine Pre-Screening Form
• Covid-19 Vaccine Pre-Screening Form (Page 1 Only)
• Johnson & Johnson Covid-19 Vaccine Information

Pediatrics Forms:

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• Consent for Treatment of Minor Child
• Consent for Treatment in the Absence of Parent
• Pediatric Medical History
• Pediatric Well-Visit Form(Age 3-5)
• Pediatric Well-Visit Form(Age 6-9)
• Pediatric Well-Visit Form(Age 10-12)
• Pediatric Well-Visit Form(Age 13-20)
• Preventative Screen Questionnaire
• PHQ-9 for Teens

Sleep Medicine Forms:

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• Sleep Questionnaire
• Epworth Sleepiness Score
• Stop-Bang Questionnaire

If you are looking for Online Secure Forms please click this: Online Forms

Please note: These documents are in Adobe® PDF format. They require Adobe Reader() to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here!