Patient Forms

Instructions:

Once you sign and complete the forms needed for your appointment, do one of the following:

• E-mail it to us at healthservices@boisestate.edu
  Disclaimer: The Health Insurance Portability and Accountability Act (“HIPAA”) recommends that E-mail that contains protected health information, such as medical records or sensitive health information, be encrypted. E-mails sent to and from Health Services are not encrypted, so E-mails may not be secure. Therefore, it is possible that the confidentiality of such communications may be unintentionally disclosed to a third party.

• Fax it to us at (208) 426-3005
• Bring it with you to your next appointment and hand it to one of our front desk staff
• Medical Records and Release of Information can be faxed to (208) 426-4059 or email medicalrecords@boisestate.edu

Medical New Patients

• Medical Paperwork
• Medical Paperwork Consent to Treat Minor
• New Patient Health History

Counseling New Patients

• Counseling Consent to Treat
• Counseling Consent & Assent to Treat for Minors
• Group Counseling Agreement

Massage

• Massage Consent
• Massage Intake

Patient Portal

• Patient Portal User Consent Form

Medical Record Release

• Release of Information Form
• HIPAA Revocation of Authorization

Appeals/Complaints

• Account Maintenance Appeal
  

Notice of Privacy Practices

• Notice of Privacy Practices

Self Pay Agreement

• Self Payment Agreement