Patient Forms

Forms & Instructions for Accessing Care at Henderson Wellness Clinic

New Patients

• Request Medical Records from Current Provider Form in English
• Request Medical Records from Current Provider Form in Spanish
• Intake Form in English
• Intake Form in Spanish

Existing Patients

• Request Medical Records – Release of Information Form in English
• Request Medical Records – Release of Information Form in Spanish​
• Patient Record Copy Fee Notice
• Complaint and Grievance Form