Forms Library

These forms are most often needed by users and Physicians. You may download and fax these forms, or complete the online equivalent. Please feel free to call us directly toll-free at 1.800.269.4659.

PDF forms can be downloaded by clicking on the PDF icon.
Form Name	Description	Download
Health Insurance Portability and Accountability Act (HIPAA)	Learn how medical information about you may be used and disclosed.
Patient Registration Form	Pre register for faster office visits
Billing Policy	Brownfield's Detailed Billing Policy
Authorization to Release Healthcare	Authorization to process insurance
Statement of Certifying Physician	For prescription placement
Patient Satisfaction Survey	Please let us know how our service was for you
Specialty Boutique Brochure	Information on our Women's Specialty Boutique