Serving the community since 1982
Contact the Office: 209.524.1264

New Patient Forms

New Patient Forms

If you would like to be a new patient with us, we have provided for your convenience, the forms necessary to establish care with us. You can download these forms and fill them out ahead of your first visit. If you need a copy of your records, you may download the Medical Release form, completely fill out and sign it, then mail it in to our office. Click on any of the files below to download a .pdf copy of them. You will need to bring all four (4) pages to your first appointment.

HIPAA Consent

Authorizes Cornerstone Family Medical Group to release your protected health information to specific, named persons.

Download

HIPAA Notification

Statement of our practices in accordance with privacy rules. A signed copy of this form must be submitted for each of our patients.

Download

New Patient Health History

Provides us with information on your relevant health history, including medical conditions, medications, and more. Required for new patients.

Download

New Patient Information

New patient form with basic contact and insurance information. Should be filled out and submitted at your first visit, or anytime the information changes.

Download

Records Release Authorization

This Authorization to Release Medical Records authorizes us to release records at your request to specific individuals or healthcare providers. Separate from the HIPAA form.

Download

Family History Questionnaire for Hereditary Cancers

Form indicating if there is a personal or family history for common hereditary cancer syndromes.

Download

Disclaimer: Information on this website is for educational and reference purposes only. Information should not be interpreted as a recommendation for a specific treatment plan, product, or course of action.

Meet our Providers

Meet our Providers

Meet our Providers