MISSION STATEMENT

Harvard Family Physicians P.C. is committed to providing healthcare to individuals and families in the community it serves, with superior quality and value.

TODAY'S HEALTH NEWS

 

    

 

 

In order to save you time when visiting Harvard Family Physicians, we have made several of our patient forms available online.

Please download and complete any of the forms below that pertain to you. Bring them, along with your insurance card and a list of current medications, to your first appointment.

 

Please confirm with your insurance carrier whether we are listed on your plan within network.

 

 

 

PATIENT INFO
 

This is a standard new patient form which includes patient information (address, phone, etc.), emergency contact, insurance provider and claims authorization.

 

  DOWNLOAD FORM

 

 

 

 

Medical Questionnaire

 

This form is a standard medical questionnaire to discover medical history. It includes past medical history, surgical history, current medications, allergies, family history, social history and systems review.

 

  DOWNLOAD FORM 

 

PAYMENT POLICY

 

This document gives an explanation regarding patient and insurance responsibility for services rendered. 

  DOWNLOAD FORM 

 


DISCLOSURE OF HEALTH
 

This is an important legal document. It allows you to decide who or whom you would like to disclose your medical records. 

 


  DOWNLOAD FORM

 

 

  

RELEASE OF MEDICAL RECORDS

 

This form should be used if you wish to release or obtain your medical records for yourself, another doctor, organization, hospital, or other healthcare provider(s).


    DOWNLOAD FORM