The forms below are available through our patient portal. Use this guide to identify which form applies to your situation before your appointment or when managing your account.
Required of all patients
All patients are required to complete this form. It authorizes Gilbert Center to securely store your credit or debit card and charge it for balances due, as described in our consent documentation.
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.
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 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 review
How we protect and use your personal health information.
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
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 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.
Bring the completed pages with you. Incomplete packets may require rescheduling.
Bring the completed form to your appointment and hand it to our front desk staff.
