Patient Forms
Choose Print Blank Form to open a copy you can print and complete by hand, or choose Fill & Print PDF to type your answers before printing. Both options use the same PDF.
Please bring completed forms with you to the office. Do not email completed forms.
New Patient / Medical History Form
Complete this form before your visit to provide your medical history, medications, allergies, insurance information and other routine intake information.
DOT Exam Forms
Coming in for a DOT physical? Complete both forms below: the two-page driver information and health history, and the one-page MedFast DOT requirements and consent. Fill them out on your computer and print them, or print blank copies and complete them by hand. Bring both completed forms to your visit.
DOT Driver Information & Health History (Pages 1–2)
MedFast DOT Requirements & Consent (Page 3)
Medical Records Release Authorization
Use this form when you want another physician, hospital or medical facility to release records to MedFast Urgent & Primary Care.
These forms are optional. If you prefer, you may complete the necessary paperwork when you arrive.
For urgent concerns, call the clinic. For a medical emergency, call 911 or go to the nearest emergency department.