PWHC Forms

Patient Forms

PWHC Medical Records Request for Release – Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

PWHC HIPAA auth to disclose PHI

Preferred Contacts (PDF) – Patients are encouraged to complete and return the Preferred Contacts Form.

PWHC Financial and Other Policies

Portal Self Check In Guide

Patient Portal Registration Instructions

PWHC Demographic Form

PWHC Dental Letter

PWHC Medical History Form