All new patients will need to complete all three forms before their first visit, either ahead of time or after arriving at the Health Center.
Returning patients should update their Patient Registration or Medical History form if any information has changed since their last visit.
The information you provide on these forms is strictly confidential.
Permission for Pill PickupDon't have time to pick up your supplies? You can send a friend to pick them up for you. Just print this form and fill it out. Then have your friend bring it to your regular PPCO Health Center, along with the necessary payment.
For information on having your pills mailed to you, click here.
Records Release to PPCO
Do you need your doctor to send your records to PPCO? Print this form and take it to your doctor's office to have your records transferred to us.
Release of Information From PPCO
Do you need your PPCO records sent to your doctor? Print this form, fill it out, and send it to PPCO. Mailing and faxing information for PPCO Health Centers is included on the form.
