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Intake Forms

Intake Forms for ABC Medical Group in Los Altos, MA

We understand your time is important. Please print out the following forms and bring them to your first appointment to help expedite the intake process. For more questions, please contact us directly or download our patient forms before you visit our Los Altos clinic. We are located at 123 ABC Ave Suite A, Los Altos, CA 123456.

Massachusetts Healthcare Proxy Form

GAD-7 Anxiety Screening

PHQ-9 Depression Screening

ACE – Concussion Screening

Confidential Communications

Acknowledgement of Privacy Rights

Massachusetts Healthcare Proxy Form

PHQ-9 Depression Screening

Confidential Communications

GAD-7 Anxiety Screening

ACE – Concussion Screening

Acknowledgement of Privacy Rights

Patient Intake Form

Patient Health History

Child Immunization Consent Form

Adult Immunization Consent

Medical Record Release

Massachusetts Healthcare Proxy Form

ACE – Concussion Screening

GAD-7 Anxiety Screening

PHQ-9 Depression Screening

Application for Disabled Parking

Informed Consent for Minor Surgical Procedures

*In case of a life threatening emergency, immediately call 911.
**For any medical procedures, patients may respond to treatment differently, each patients results may vary.
***The photos on this website are for illustrative purposes only. The individuals pictured are models unless explicitly identified as a client/patient/customer/staff/employee.
****Information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content contained on or available through this site is for general information purposes only.
*****By using this website and sending us your information, you are giving us permission to contact you by electronic and non-electronic means. We also track the conversions and collect user data to improve marketing.
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*******If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact us.

ABC Medical Group

123 ABC Ave Suite A, Los Altos, CA 123456

Fax: (650) 765-4321

Hours of Operations

Mon-Fri: 8am-6pm & Sat-Sun: 8am-1pm

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