Downloadable Forms

You may download and print the following PDFs from the list below.

You will need Acrobat Reader to view these files.

Parent Access Form
(For patients 18 years and older who wish to authorize a parent to have access to their records)

Authorization to Release PHI (Protected Health Information)
(For transferring your child's records to a new provider OR requesting your child's records from their previous provider) 

Consent to Treat Form 
(For authorizing a stepparent or another adult to accompany your child to an appointment and receive information about his/her care)
Enola Office • 1824 Good Hope Road, Suite 201 (717) 791-2680
Camp Hill Office • 25 West Shore Drive (717) 791-2680