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Patient Forms

Download and complete these forms before your visit to save time and ensure we have all the information needed to provide you with the best possible care.

New Patient(2)
Consent Forms(2)
Medical Records(2)
Functional Medicine(1)
DPC Membership(1)
Tools(1)

All Forms

Click on any form below to download it as a PDF. You can complete these forms digitally or print them out and bring them to your appointment.

New Patient
New Patient Registration Form
Featured
Basic information form for all new patients including contact details, emergency contacts, and insurance information.
125 KBUpdated: January 2025
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New Patient
Medical History Questionnaire
Featured
Comprehensive health history including past medical conditions, surgeries, medications, and family history.
186 KBUpdated: January 2025
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Functional Medicine
Functional Medicine Assessment
Detailed questionnaire covering lifestyle, nutrition, stress, sleep, and environmental factors affecting your health.
245 KBUpdated: January 2025
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Consent Forms
Consent for Treatment
General consent form for medical treatment and procedures at Lotus Direct Care.
98 KBUpdated: December 2024
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Consent Forms
Privacy Practices Acknowledgment
HIPAA privacy notice acknowledgment form regarding the use and disclosure of your health information.
112 KBUpdated: December 2024
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DPC Membership
Direct Primary Care Agreement
Membership agreement outlining the terms of our Direct Primary Care services and fee structure.
156 KBUpdated: January 2025
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Medical Records
Medication List Template
Template to list all current medications, supplements, dosages, and frequencies.
75 KBUpdated: January 2025
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Medical Records
Release of Medical Records
Authorization form to request medical records from previous healthcare providers.
92 KBUpdated: December 2024
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Tools
Symptom Tracker
Daily symptom tracking journal to monitor your health between visits.
134 KBUpdated: January 2025
Download Form

Form Submission Options

Online Portal

Upload completed forms securely through our patient portal.

Access Portal

Email

Send completed forms to forms@lotusdirectcare.com

Send Email

In Person

Bring printed forms to your appointment.

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Need Help with Forms?

Our staff is happy to assist you with any questions about completing your forms or to help you determine which forms you need.