Forms

Forms are available in PDF format. Please download and print these forms, then bring them with you to our office or send them to the office at the address below.

New Patient Request Form

Medicare Wellness Questionnaire

Privacy Disclosure

Receipt of Privacy Disclosure Form

Accountable Care Organization Notice of Participation

Family Medical Clinic | 1170 North Main Street, Arab, AL 35016 | Phone: (256) 586-4127 | Fax: (256) 586-0535

HIPAA Notice of Privacy Practice