Patient Forms

For your convenience, we have provided a few downloadable forms that may be needed throughout your patient journey. Please print, complete, and return the forms by dropping off in person at our Springdale clinic or you can email to [email protected]. Please do not hesitate to call us at (479) 750-2080 if you have any questions or concerns.

• Authorization to Release Health / Medical Information
• Authorization for Verbal Communication with Family Member
• Consent to Treatment of Child by Authorized Persons
• HIPAA Notice of Privacy Practices
• Patient Referral Form
• Recording Policy