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Patient forms

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View and download forms and policies before your Polyclinic visit.

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Additional resources

Find forms, questionnaires and checklists for specialty care and services.

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Hubs Component

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  • Medical forms
  • Legal and privacy forms
  • Patient information

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Clear liquid diet guidelines

Use this guideline when preparing for your GI procedure.

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Notice of Privacy Practices

This form explains how we may use information about you.

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Financial assistance form

Use this form to ask for help paying your bill.

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Solicitud de asistencia

Use este formulario para obtener ayuda para pagar su factura.

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Request for alternative means of confidential communications

Fill out this form to state the type of communication you prefer.

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Living healthier with Medicare Advantage

Read our guide.

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Medicare comparison chart

Compare plans to see if Medicare Advantage is right for you.

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Prepare your Medicare checklist

Signing up for Medicare is easy. Our guide tells you how.

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Authorization for treatment of a minor

Fill out this form to allow medical care for your child.

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Authorization to release medical records

Fill out this form to release medical and billing records.

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Depression form (PHQ-9)

This screening tool helps determine if you are depressed.

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Patient rights and responsibilities

Please read this document before your visit.

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