• direct patient care home
  • about the provider & staff
  • schedule an appointment
  • forms
  • Walk-in services with fees
  • Becoming a Member or Patient
  • Member services
  • Functional Medicine & Integrative Services
  • Weight Loss Program
  • Small Business Owners
  • Healthy Living
  • COVID-19 Testing
  • patient and community education
  • contact us
  • blog
  • FAQs
  • Mental Health Counseling
  • Health Coaching
  • Functional Nutrition
THRIVE DIRECT HEALTH CARE
  • direct patient care home
  • about the provider & staff
  • schedule an appointment
  • forms
  • Walk-in services with fees
  • Becoming a Member or Patient
  • Member services
  • Functional Medicine & Integrative Services
  • Weight Loss Program
  • Small Business Owners
  • Healthy Living
  • COVID-19 Testing
  • patient and community education
  • contact us
  • blog
  • FAQs
  • Mental Health Counseling
  • Health Coaching
  • Functional Nutrition
THRIVE DIRECT HEALTH CARE

Forms

Forms needed 

Membership Specific Forms

For all visits:
Read the Notice of Privacy Practices and sign the HIPAA form. Form also available on site. 

Everyone needs the following:

Privacy Rights
Printable: HIPAA
Fillable: Hipaa

Release of Protected Health Information: optional--allows for transfer of health information from your previous provider or other entities. ​​
printable: Authorization for Release of Protected Health Information
Fillable: Authorization for Release of protected health information

HEALTH HISTORY
Printable: Patient Registration and History
​(In-person Visits)
fillable: PATIENT REGISTRATION AND HISTORY ​(IN-PERSON VISITS)
TELEMEDICINE
PRINTABLE: Telemedicine Consent & Registration
FILLABLE: Telemedicine consent & Registration
Membership Service Guide
Membership Agreement
The Membership Agreement is also located online with the below online registration process. 
Membership Fee Registration Worksheet
a la carte menu

Membership Fees are processed through a secure payment platform called hint.com which utilizes Stripe--To register for membership contact the clinic. After your initial appointment you can receive a link or fill out paper documents. ​Medicare B patients are ineligible for membership. If Medicare Advantage, please contact the clinic.  


Pediatrics | Well Child | Acute Care for Children
​

INFORMATION ABOUT YOUR VISIT
what to expect with your well child visit
Milestone and immunization tracker
HEALTH HISTORY​
PRINTABLE: HEALTH HISTORY FORM
FILLABLE: HEALTH HISTORY FORM

Other Forms

Sports Physicals and other Physicals
This form is a general school physical form and is widely accepted at most schools. This form can also be used for employment. Please have other specific forms available at time of visit if needed. 
For walk-in, please print, pre-complete and bring the following with you or arrive 10 min early to complete. 
printable: Sports Physical Form
CHRONIC PAIN 
Chronic Pain Forms
For Medicare B and Pain Membership Only. 
-Members: in addition to normal membership paperwork
DOT/CDL FORMS
You will be provided an instant copy of certification after the completion of the exam IF you qualify. If other supporting documentation is needed you will get a 50% refund which can be repaid once the documentation is obtained and you complete the exam requirements. 

Examples of needed documentation:
  • Sleep Study
  • EKG
  • ​Pulmonary Function test if you have COPD, asthma or are a current smoker. 

**IF you need assistance in obtaining these please use the contact us form to schedule for these in office tests (extra fee for non-members). 
For walk-in, please print, pre-complete and bring the following with you to speed up the check in process. or arrive 20 minutes early. ​You will have to provide a urine sample for chemical dip only. Drug tox is not apart of this exam. 
DOT/CDL Forms
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