Identity Health Clinic Forms

Forms to become a new patient with Identity Health Clinic (please also see this step by step guide for how to register as a new patient with Identity Health Clinic) 

  1. New Patient Registration Form
  2. Patient Policies
  3. HIPAA authorization
  4. ID + insurance card
  5. Health History 
  6. Release Of Information (ROI)
    1. The ROI is optional – please fill out if you need Identity Health Clinic to be in communication with any of your other healthcare providers, case managers, etc.
  7.  Consent for Estrogen Hormone Therapy
  8. Consent for Testosterone Hormone Therapy
  9. Consent for Puberty Blocker Therapy