Family Health Center of Montclair 48-50 Fairfield Street ¤ Montclair, NJ ¤ 07042 ¤ 973 744 8511
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	New Patient Forms If you are a new patient to our office, printing out, filling out, and bringing these forms with you when you come will make your visit faster and easier. The forms are all in PDF format. If you cannot open any of these files, download Acrobat Reader from Adobe. Notice of Privacy Practices (HIPAA disclosure form). Please read this form that explains our practices for keeping your medical information confidential and how you can access your information. Notice of Privacy Practices Acknowledgement (HIPAA disclosure form pt. 2). When you have read the Notice of Privacy Practices, please print and sign this form acknowledging that you are aware of our practices. Patient Financial Policy Statement. Our policy on payment and insurances. Patient Insurance Information. This form asks for your insurance information for our records. Authorization to Use or Disclose Protected Health Information. Authorization for us to access your medical records. You only need to fill out this form if you have previous medical records with another doctor that you would like to allow us to access.