Chino Hills Family Medical Group
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  • Home
  • COVID-19
  • About
  • Contact
  • News
  • Patient Forms
  • Patient Portal

New Patient Complete Packet:

CHFMG New Patient Packet
File Size: 734 kb
File Type: pdf
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Additional Forms:

CHFMG Patient Registration Form
File Size: 56 kb
File Type: pdf
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Office Policies
File Size: 229 kb
File Type: pdf
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HIPAA Consent Form
File Size: 259 kb
File Type: pdf
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Lab and Diagnostic Imaging Form
File Size: 224 kb
File Type: pdf
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Record Release Form
File Size: 455 kb
File Type: pdf
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Notice of Privacy Practices
File Size: 6219 kb
File Type: pdf
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Authorization to Treat Minor Form
File Size: 40 kb
File Type: docx
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Minor Self Authorization Form
File Size: 108 kb
File Type: pdf
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Outgoing Medical Release
File Size: 40 kb
File Type: docx
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Flu Vaccine Consent Form
File Size: 143 kb
File Type: pdf
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Cash Fee Schedule (Effective May 21, 2017)

CHFMG Cash Fee Schedule
File Size: 216 kb
File Type: pdf
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