Downloadable Forms: Patient Forms, Medical release, HIPAA

These forms are in PDF format (.pdf). Please download and install the latest version of Adobe Reader if you cannot open the files.

Click on a link below to open a printable PDF document file:

          Patient Forms:

·         New Patient Registration forms (Spanish)

·         New Patient Registration forms (English)

          Patient History English

          Patient History Spanish

·         Poliza y acuerdo financiero

·         Financial Policy

·         Medical release forms:

          Authorization release Medical Record

          Request for Correction / Edit to Medical Record

·         Medical Records Request Forms- English

          Medical Records Request Forms- Spanish

          HIPAA Forms:

·         HIPAA Notice of Privacy Practices- English

          HIPAA Notice of Privacy Practices- Spanish

          HIPPA Authorization English

          HIPAA Authorization Spanish

          Notice of Privacy English

          Notice of Privacy Spanish

© 2017 Rocha Medical Clinic

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3727 Roosevelt Avenue San Antonio, TX 78214

Tel: 210-922-5922

19575 K St Somerset, TX 78069

Tel: 210-922-1144