Documents and Privacy Practices

en Español

Before your first appointment, you will need fill out the New Patient Packet for the service you are receiving. If you have access to a printer, please print and bring these forms to your first appointment.

    New Patient Packets

    Adult Medical,  Behavioral health, social work, OB/GYN 



    Patient Handbook - includes your Patient Bill of Rights & Responsibilities and Privacy Practices 


    Other Important Information - Your Patient Portal! Communicate with your Chase Brexton provider, make a fast, secure bill payment, request a prescription refill, view your lab results, and much more. 

    Verification of No Income:  English // Spanish

    Sliding Fee Scale FAQ: English // Spanish

    Allow Chase Brexton to Discuss Your Care: English  //  Spanish

    Request Records from an Outside Provider:   English  //  Spanish

    Request Records from Chase Brexton: English  //  Spanish

    Designation for Another Person to Consent for Medical Care Form: English // Spanish

    Your Health History - A Short Record for Your Own Knowledge