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Patient Information
Every organization has to have policies – and Evergreen is no exception. The policies (see links below) provided on
this page include our General Policy, Privacy Policy, New Patient Application form,
Patient Registration form, and Health History Questionnaire.
Our General Policy covers our financial policy, missed appointments, and treatment of minors. The
Privacy Policy details the handling of your PHI (Patient Health Information). The
New Patient Application form must be completed, submitted and approved to become a patient at Evergreen Family
Medicine. Once your New Patient Application has been approved, you will be asked to complete the
Patient Registration form. Our Health History Questionnaire provides Evergreen with valuable information
regarding your health, current and previous issues. We ask that you complete a Health History Questionnaire before
every visit to Evergreen Family Medicine.
These Policies and Forms are provided for your convenience.
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General Policy
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Privacy Practice Notification
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New Patient Application
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Health History Questionnaire
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