Patient Forms
Complete Forms Online
Complete and submit forms online through this portal. If you are a new patient please fill out all the forms that start with “Acacia New.” https://afmg.mymedaccess.com/public-forms
Alternatively, Print Forms
Complete and bring to appointment.
Privacy / HIPAA Policy
Please read our Privacy Policy and sign the acknowledgement below
Forms Required Upon First Visit and Annually
Update health history and registration form annually. Please provide a copy of both sides of your current insurance card or cards if you have more than one. Note: an individual is not considered a patient of Acacia Family Medical Group unless he or she has visited our office and been examined by one of our physicians or physician assistant.
- New Patient Registration Form
- Patient History Form
- Financial Policy Form
- Acknowledgement of Receipt of Privacy Notice
- Patient Request for Medical Records Release
New Patient Forms Required Upon First Visit - Pediatric
Update health history and registration form annually. Please provide a copy of both sides of your current insurance card or cards if you have more than one. Note: an individual is not considered a patient of Acacia Family Medical Group unless he or she has visited our office and been examined by one of our physicians or physician assistant.
- First Visit Pediatric Form
- Patient History Form
- Financial Policy Form
- Acknowledgement of Receipt of Privacy Notice
- Patient Request for Medical Records Release