Patient forms & when to use them

When to Complete

Complete this form to authorize Gilbert Center for Family Medicine to securely store your credit or debit card and charge as described in the consent.

When to complete

Complete this form when you would like to remove your stored credit card information from your account. Please note that a card on file is required for active patients — you may be asked to update your payment information at your next visit.

When to complete

If you are a parent or legal guardian and are unable to be present at your minor child's appointment, this form authorizes Gilbert Center to provide care in your absence. It must be completed and submitted prior to the scheduled visit.

When to complete

Complete this worksheet when your employer, school, or insurance carrier requires documentation to support a request for medical leave, a workplace accommodation, or a disability determination. Please complete prior to your scheduled appointment to discuss your requested accommodations. Please bring any employer-specific forms as well, as requirements vary.

Required of all patients annually

Use this form to update your authorization for the release of your health information. Complete it whenever you need to add, change, or remove individuals that our office is permitted to speak with regarding your care.

When to complete

Complete this form when you need to send your records to another provider or facility, or when requesting a copy of your records for yourself. This form covers both outgoing releases and incoming transfer requests.

When to review

How we protect and use your personal health information.

When to review

This document outlines Gilbert Center's policies on two important topics: our controlled substance prescribing policy and the evaluation process for Emotional Support Animal (ESA) letters. Please review it carefully, as it describes expectations for patients receiving or requesting these services.

When to complete

If you believe information in your medical record is inaccurate or incomplete, you may submit this form to request a correction. Our team will review your request and respond in accordance with applicable privacy regulations.

When to complete

Required for patients seeking a sports participation physical. This is a multi-page packet — patients (or parents/guardians of minors) are responsible for completing pages 1–4, 9, and 10 before arriving at the appointment. Page 8 is completed by your healthcare provider during the visit.