Patient Forms

1. Forms

Release of Information Request

HIPAA Confidential Communications Form | Text Version

Columbus Medical Clinic
Demographics Form (English) | Demographics Form (Spanish)

Columbus Medical Clinic Patient History Form | Text Version

Columbus Medical Clinic Pediatric Patient History Form | Text Version

Four Oaks Clinic
Demographics Form (English) | Demographics Form (Spanish)

Four Oaks Clinic Medical History Form | Text Version

2. Documents

Notice of Privacy Practices

Patient Rights and Responsibilities | Text Version

Patient Guide | Text Version

For requests for Medical Records please complete the Release of Information request form and email to release@columbusch.com.×

1. Forms for Dr. Buckle -- Orthopedics

New patient form | Pediatric | English | Espanol 

Patient registration form | English | Espanol

HIPAA acknowledgement and consent | English | Espanol

Fall risk assessment | English

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