The documents listed below are the forms you will be asked to review and sign as part of the new patient registration process. Signing is completed electronically through our patient intake system at the time of registration.
You are welcome to review any of these forms in advance. If you have questions about a specific form, please contact us before your appointment.
Privacy & Compliance Resources
The following forms relate to your rights and our obligations under the Health Insurance Portability and Accountability Act (HIPAA) and applicable privacy laws.
- APNS HIPAA Acknowledgement
- APNS HIPAA Privacy Policy
- APNS HIPAA Summary
- APNS HIPAA Right to Complain
- APNS HIPAA Complaint Form
- APNS HIPAA Communication
- APNS HIPAA Restrictions
- APNS HIPAA Amendment
- APNS HIPAA Accounting Disclosure
- APNS Notice of Privacy Practices
- APNS Privacy Practice Receipt
PHI & Disclosure
The following forms relate to the use, release, and control of your Protected Health Information (PHI).
- APNS PHI Disclosure
- APNS PHI Amendment Form
- APNS Consent for Disclosure
- APNS Accounting Disclosure Request
- APNS Health Info Release
- APNS Control of Med Records
- APNS Access to Health Info
- APNS California Opt Out Request Form
Consent & Treatment Agreements
The following forms relate to your consent to receive care and any applicable treatment-specific agreements.
- APNS Consent to Treat – Adult
- APNS Consent to Treat – Minor
- APNS Telehealth Consent
- APNS Mental Health Treatment Agreement
- APNS Enclomiphene Agreement
- APNS PDE5 Inhibitor Agreement
- APNS GLP-1 Agreement
Patient Rights & Responsibilities
The following forms outline your rights and responsibilities as an APNS patient.
- APNS Patient Responsibilities
- APNS Patient Behavior Policy
- APNS NP Acknowledgement
- APNS Advanced Directive Receipt
Financial & Insurance
The following forms relate to billing, payment, and insurance obligations.
Questions?
If you have questions about any of these forms prior to your appointment, please contact us directly.