Documents and Privacy Practices

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, Case Management, OB/GYN 

Dental

Pediatrics

Other Important Information

MyChaseBrexton.org - 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. 

Notice of Privacy Practices

Patient Bill of Rights

Fee Scale Application:  English // Spanish

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

 

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