Helpful Forms for Download
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The Baton Rouge Clinic provides the following forms to save our patients time in the waiting area, provide a venue for feedback and allow new patients to contact us.
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* MEDICAL RECORDS: Release of Protected Health Information:
Release FROM The Baton Rouge Clinic, AMC
Release TO The Baton Rouge Clinic, AMC
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* MRI FORMS: Questions, surveys and authorization forms.
MRI Procedure History Form (pdf)
MRI Screening Questionnaire (Hazard Checklist, pdf)
MRI Patient Instructions (pdf)
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* MISCELLANEOUS FORMS:
Mammogram Questionnaire (pdf)
Bone Density Study Questionnaire (pdf)
Sleep Questionnaire (pdf)
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* HEMATOLOGY / ONCOLOGY NEW-PATIENT FORMS:
Medical History Form (pdf)
Medication List Form (pdf)
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Whether it is primary care for all ages - infants through geriatrics, or specialty care for complex disease states, or consultations, or second opinions, The Baton Rouge Clinic is prepared to help you!