Forms and Policies

Forms

Here you will find our most commonly used forms. You may print and complete these forms at your convenience and bring to your first SOCPA  visit.

General Forms

• Patient Information Form (English) (Spanish)
• New Patient Questionnaire (English) (Spanish)
• Caregiver Authorization Affidavit (English) (Spanish)
• Consent Form (English) (Spanish)
• Consent to Treat a Minor (English) (Spanish)
• Eligibility Guarantee (English) (Spanish)
• EZ-Pay Consent Form (optional)
• Request for Medical Records
• Adding Your Newborn to Your Policy

Vaccine Forms

• Adult Vaccine Waiver
• Flumist Vaccine Form
• Influenza Waiver Form

Policies

• Financial Policy (English) (Spanish)
• Forms Policy
• Notice of Privacy Practices
• Sick and Well Visit Policy

All documents can be viewed and printed with Adobe Reader. If you find that you are unable to access these documents, click the link below to download the latest version of Adobe Reader.