IKPFM – Patient Resources

Forms To Assist With Your Visit

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IKP Family Medicine Financial Policy & Patient Consent Form

IKP Family Medicine HIPAA Disclosure Form

Release for Treatment of a “MINOR” without a Parent

Patient Registration Information

Medical Records Request Form

UIL Pre-participation Sports Physical Form

Medication Information Release Form

Credit Card Authorization Form

Immunization Registry Adult Consent Form

Immunization Registry Minor Consent Form

IKP Family Medicine – Policies

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