NFP
Forms

Patient Forms

Save time at your appointment by downloading and completing these forms in advance.

Required Documentation

Patient Forms

Please download and complete these forms before your appointment to save time during your visit.

New Patient Registration Form

Required for all new patients. Please complete this form prior to your first appointment.

Authorization to Release Information

Authorizes us to release your medical information to other healthcare providers involved in your care.

Minor Authorization Form

Required for patients under 18 years of age to authorize treatment.

Privacy Notice

Details our practices regarding your protected health information and privacy rights.

Peripheral Arterial Disease (PAD) Form

Assessment form for peripheral arterial disease symptoms and risk factors.

Hoag Opt Out Form

Optional form to opt out of the Hoag Health Information Exchange program.

Submission Instructions

Form Submission Options

For your convenience, you can submit your completed forms in several ways:

Option 1

Bring to Your Appointment

Print and complete the forms, then bring them with you to your scheduled appointment.

Option 2

Email

Complete the forms electronically (if fillable) or print, complete, and scan them. Then email them to info@newportfamilypodiatry.com.

Option 3

Fax

Fax your completed forms to (949) 650-1902.

Important Notes

  • Please arrive 15 minutes early if you plan to complete forms at our office.
  • Bring your insurance card and photo ID to your appointment.
  • If you have any questions about these forms, please contact our office at (949) 650-1900.