Patient Registration Forms & Privacy Practices

Registration Information

At The Frist Clinic, we want your registration process to go as smoothly as possible. That is why we have created a guide to help ease the process. You may print the following forms and complete them prior to your appointment:

• Patient Registration Form
• Medical Information Release Form

When registering, you may be asked to sign the following forms:

• Consent for Treatment
• Authorization to bill your insurance

Medicare recipients may be asked to sign:

• Medicare Secondary Questionnaire
• Medicare Rights Statement

Champus recipients may be asked to sign:

• Champus Rights Statement

To ensure accurate and timely billing, please remember to bring the following items with you at the time of registration:

• Social Security Card (if available)
• All active insurance cards
• Picture ID
• Advance Directives (if you have these) - Living Will or Durable Power of Attorney

HIPAA Information

The Frist Clinic is committed to protecting the healthcare information of its patients pursuant to the Federal guidelines outlined in the Health Insurance Portability and Accountability Act (HIPAA).

• Notice of Privacy Practices
• Aviso Sobre Las Practicas de Privacidad

Note: To view the forms on our website, you'll need Adobe Acrobat on your computer. If you don't have Adobe Acrobat, you can download this free software by clicking the icon below.