Forms & Records

FORMS

Most forms are available on our Titan Health portal.

Immunization Waiver FormPDF File Opens in new window

Informed Consent for Chiropractic CarePDF File Opens in new window

Minor Consent FormPDF File Opens in new window
If you are the parent of a minor under 18 years of age, please fill this form out and fax it back to us at 657-278-3069.

No Show/Late Appeal FormPDF File Opens in new window

Medical Consent FormPDF File

 

MEDICAL RECORDS

The mission of Medical Records is to maintain complete and accurate medical records, to safeguard all information against loss and use by unauthorized persons, to maintain medical records in a manner permitting prompt retrieval, and to assist Health Services staff and patients as necessary.

To request medical records for yourself or another provider/health facility:

  1. Print, complete, and sign a copy of the Authorization For Release of Information Form.PDF File Opens in new window
  2. Submit by mail, fax, or walk in.

* Pricing for records may vary.