New Patient Forms

Welcome to Jordan Valley! As a patient here, you will need to fill out a few forms. You can print these forms and fill them out before your appointment, or we will give you a copy to fill out at the clinic.

New Patient Paperwork

When you visit our clinic for the first time, you will fill out a form called “New Patient Paperwork.” You’ll also update this form once a year.

This paperwork asks for important information to help us talk with you. It asks for your address, phone number, and the language you prefer to speak.

The paperwork lets us know we have your permission to treat you. You can also give us permission to talk with other people or organizations about your care.

Medical History

When you visit us for the first time, you will fill out a form called “Medical History.” This form asks questions about your past medical conditions, surgeries, medications, allergies, and your family’s medical history. Your answers help us give you the best care possible.

If you are 18 or older, you will fill out the “Adult Past Medical History” form. For patients under 18, a parent or guardian should fill out the “Pediatric Past Medical History” form.

Patient Rights & Responsibilities

Patients have rights concerning their care and treatment. We ask that you take responsibility for certain actions regarding your care. We trust our patients to provide accurate information, keep their appointments, ask providers questions, and respect other patients and staff.

Review our “Patient Rights and Responsibilities” flyer. Before visiting us, make sure you understand your responsibilities as a patient.

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