Below are a listing of patient forms to be filled out prior to the patient's first appointment. All forms are available at the RCBM offices; however, if you click on the links below, you may print and fill out the forms prior to your appointment. Once completed, you may bring them with you to your appointment.

Welcome to RCBM - New Patient General Information (PDF)

Patient Information Form (PDF)

PLEASE NOTE: If you have been asked to complete the ‘EMR Information Form,” you do not need to complete the medication list within the “Patient Information Form,” as this information is contained within the former.

EMR Information Form (PDF)

Payment Policy (PDF)

Medication List (PDF)

Adult Confidential History Form (PDF)

Child/Adolescent/Parent Confidential History Form (PDF)

Patient Change of Information Form (PDF)

HIPPA Privacy Notice (PDF)

Release of Information (PDF)

Please note that there will be a $30 processing and additional $5 shipping and handling fee for the copy and transfer of medical records. We appreciate your cooperation.

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