Please click on the form you wish to download.
English Forms
- Consent for Medical Treatment NON-parent
- Consent for Medical Treatment Minor Alone
- Authorization for use or disclosure of Patient Health Information (FROM: another facility, TO: LiveWell)
- Authorization for use disclosure of Patient Health Information (FROM: LiveWell, TO: patient or another doctor)
- Patients Bill of Rights
- Notice of Privacy Practices
Spanish Forms
- Consent For Medical Treatment NON-parent (Spanish)
- Consent For Medical Treatment Minor Alone (Spanish)
- Authorization for use or disclosure of Patient Health Information (FROM: another facility, TO: LiveWell)
- Authorization for use or disclosure of Patient Health Information (FROM: LiveWell, TO: patient or another doctor)
- Bill of Rights – Patients – Spanish
- Notice of Privacy Practice – Spanish
