All Patient Forms are in PDF format.

Please click here in order to download the FREE Adobe Acrobat PDF Reader.

Patient Forms

If you are a new patient, please plan to arrive at least 20 minutes early to your first appointment to allow time to complete the necessary paperwork. To save you time on the day of your appointment, you may download our New Patient Forms and complete them prior to your appointment. Please remember to bring the completed forms along with your insurance card, photo id and co-payment with you to your appointment.

The following forms are provided for your convenience. Please print out each form on white paper and use black ink pen to complete forms. Bring these forms to our office after completion.

Links To Download Patient Forms:

New Patient History Form

New Patient Registration Form

Prescription Refill Policy

Patient Responsibility

Record Release Forms

If you would like to request your records from another provider or are looking to request records from Azalea City, please complete the form below that best suits your need. All completed forms must be sent to our office via mail or fax 251-344-5321.

Links To Download Record Release Forms:

Medical Record Release to Another Provider

Medical Record Release from Another Provider to Azalea City