Tohickon Internal Medicine
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NOTE- The titles below in blue are active links. Click on the title to open documents.

New Patient Information

New Patient Registration Packet - This packet contains important documents  needed for your initial visit to our practice. Please download them, review them and save them for future reference. Unfortunately we have no means  for secure electronic transmission of the forms they therefore must be printed and carried with you at your first appointment.

On your first appointment please bring:
  1. All of the New Patient Forms reviewed, completed and signed
  2. Your current active insurance card.
  3. Any medications your currently taking, preferably in their labeled  bottles.
  4. Previous medical records if possible.

Click on this link for New Patient Form Packet
Click on this link for New Patient Information Document

New Patient Medical Records

We recommend the following procedure for patients transferring into the practice:
  • Contact the offices of your former doctor(s) to request your medical records.
  • Request the records be sent to you prior to your first visit.  The General Medical Records Release Form  below is provided for your convenience.
  • Bring the records with you to your first visit or as soon  as possible there after. After your providers review, all records  will be returned to you.
  • Please do not have records sent directly to this office before your first visit.
              General Medical Records Release Form - 1 Page 

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Wellness Visit Form Please complete this form and bring to your next appointment.

NEW- In an effort to streamline your annual wellness exam we have developed a one page form that will help you thoroughly and conveniently list updated health information prior to your appointment. Please print and complete form then bring it to your wellness visit.Thank you.
Click on the following link to print the form:


    Annual Wellness Visit Update Form- 1 Page


 Patient Information

Tohickon Notice of Privacy Practices (HIPPA Policy)

Brochures
Annual Wellness Visits- What to Expect
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Patient Centered Medical Home


Tohickon Patient Portal User Guide

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  • Home
  • ABOUT US
  • Services
  • Forms/ Downloads
  • News
  • Links