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Forms & Policies
Everything You Need to Know

Please click the buttons below to be brought to each form. 
TMS Forms can be found at the bottom of this page. 

Adult Registration Packet

Currently, we are accepting new adult patients if they are immediate family members of current patients who are living in the same household.  The link for our new patient packet is here. We will be in contact with you with the next steps.

 

Child Registration Packet

AFP is now currently accepting children up to the age of 12. Please fill out the form by selecting the link. 

The link for the packet is here. We will be in contact with you with the next steps.

 

Authorization To Obtain Medical Information

This specific form authorizes us to obtain your records from your previous provider. For example, if you are new to Atkinson Family Practice, fill this form out and we can obtain your records from your old practice.  To access the Authorization for Release of Medical Information form, click on the link below.

Medical Release Form

Authorization for Disclosure of Medical Information

This specific form authorizes us to send your records to another practice. For example, if you are moving and need us to send your records to a new practice, or are seeing a specialized doctor and they need to see your medical history, fill out the information of where you want the records to be sent.  Please note: there is a fee to disclose records to yourself.  We ask for 30 days notice to send medical records.

Medical Disclosure Form

TMS Forms

Please email here if you have any questions about the forms below.

Please fill out either of the forms below to see if you are qualified for treatment. 

Please fill out the following forms before your appointment:

Patient Expectations at Atkinson Family Practice

Patients accepted to AFP understand the value of our Medical Home.  We promote health as a priority, despite our busy lives.  However, we cannot offer quality medical care without seeing you. For this reason we will terminate patients from the practice for any of the following reasons:

  • No-show/late cancel for 3 appointments

  • No-show/late cancel for 2 Physical Appointments

  • Breach of our Code of Conduct

  • Non-compliance with our treatment plan

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