Exceptional Care for Patients. Exceptional Careers for Physicians.
Coastal Medical Patient Forms
Please see below for several forms that may be helpful to you as a Coastal Medical patient.
- New Patient Forms Packet - Adult and Family (PDF)
- Notice of Privacy Practices - HIPAA (PDF)
- Advance Care Planning:
- Permission to Discuss (PDF)
- Request for Medical Records - New Patients (PDF)
- Request for Medical Records - from Coastal Medical (PDF)
- Pediatric Patient Information (PDF)
- Pediatric Medical History Form (PDF)
- Pediatric Stimulant Medication Agreement (PDF)
Request for Medical Records
Requests for patient's medical records will be billed to the patient according to state regulations.
Online Forms for Requesting a copy of Medical Records
- Patient Online Access Form - for individual patients or their legal guardians to request medical records.
- Third Party Request Portal - for healthcare providers, attorneys or those requesting the medical records of someone other than themselves (and who are not the legal guardian).