Patients > Patient Forms

For patient convenience new patients are able to download the necessary forms to fill out before your appointment. This will save you time when checking in.

Adair County Medical Forms
  Adair County Medical Clinic New Patient Forms
  Worker's Compensation Form
  Automobile Accident Form
  Consent Form
  Sports Physical
  Hippa Form
  Handicap Plates

1st Five Well Child Forms
  9 Month Questionnaire
  18 Month Questionnaire
  24 Month Questionnaire
  30 Month Questionnaire

Employer Form
  Client Authorization for Treatment

Adair County Specialty Clinic Forms
  Urology New Patient Form - Zafar
  Dermatology New Patient Form - Nelson and Folkers
  Podiatry New Patient Form - Neustrom
  Release of information - Stuart Clinic
  Release of information- Gf Clinic

Cardiopulmonary Rehab Forms

C.A.R.E. + Program:
  Patient Information Form
  Medical Clearance Form
  Informed Consent Form

Pulmonary Rehab:
  Patient Education Assessment Form

Cardiac Rehab:
  Patient Edcuation Assess Form

Flu Vaccine Form
  Flu Vaccination Form

  Privacy Act