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Contact
Advocare Long Logo

Chalfont Internal Medicine

Chalfont 215-394-0400
Advocare Long Logo

Chalfont Internal Medicine

Appointments
Pay My Bill
Patient Portal
  • About Us
  • Provider
  • Staff
    • Medical Assistant
    • Front Desk
  • Office Info
    • Appointments
    • No-Show Policy and Fee
    • After Hours
    • Walk-Ins
    • Insurance
    • Well Visits
    • Sick Visits
    • Emergencies
  • Forms
  • Resources
    • Affiliated Hospitals
    • FAQs
  • Location

Forms

Forms & Policies

Prior to your appointment, the forms listed below can be printed for your convenience. Filling them out beforehand will save you time by not having to complete them during your appointment. If you elect not to fill out these forms ahead of time, please arrive 15 minutes prior to your scheduled time.

Annual Patient Packet Forms

Adult Patient Registration (PDF)
Annual Consent and Acknowledgement (PDF)
Notice of Privacy Practices (PDF)
Adult Patient Registration (PDF)
Annual Consent and Acknowledgement (PDF)
Notice of Privacy Practices (PDF)
Notice of Privacy Practices - Arabic
Request for Amendment to Protected Health Information
Vaccine Consent - Spanish
Vaccine Consent - Turkish
Practice & Payment Philosophy (PDF)
Patient Portal: FAQs (PDF)
Authorization for Use & Disclosure of Protected Health Information (PHI) (PDF)
(Medical Records Release)
Healow Trifold (PDF)

Patient Forms

Notice of Privacy Practices - Arabic
Request for Amendment to Protected Health Information
Vaccine Consent - Spanish
Vaccine Consent - Turkish
Practice & Payment Philosophy (PDF)
Patient Portal: FAQs (PDF)
Authorization for Use & Disclosure of Protected Health Information (PHI) (PDF)
Healow Trifold (PDF)

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Patient Forms

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