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Files & Forms

Patient Demographics

Important Info

This form is required for all new patients with or without insurance. We also ask that if you have had a change of address or phone number that you update that information with our clinic. You can also use this form to update emergency contacts and people who you do or not authorize to have access to your protected healthcare information. Feel free to print this form and bring it in, mail it, or send it to our email

Coordination of Benefits Update

Key Facts

If your insurance company is requiring an update to your coordination of benefits this form will help guide you through the steps as painlessly as possible.

Send Central Stat Care Your Records

Good to Know

If you want your medical records released to Central Stat Care here is the form you need! Fill it out and send it over to any previous physicians or facilities.

Send Your Records Somewhere Else

Good to Know

If you want the medical records at Central Stat Care to be released to someone else you must complete a Medical Records Release Request and submit it to our office.

Files & Forms: Files
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