Forms

Saving you time so you can focus on the care you need. It’s just one way we deliver a better patient experience.

Patient Forms

Save time at your appointment by completing some forms ahead of time.

Jumpstart your health and save time in the office by completing forms online. For a seamless experience, check your Patient Portal to see if any forms are waiting for you. Patient Portal forms directly link to your chart and can be accessed by your care team. Otherwise, you may download and print any appropriate forms below to bring with you to your upcoming appointment.

To view and print the forms below, you will need Adobe Reader. This is a free program that usually comes with your computer. If you don’t have it, you can download Adobe Acrobat Reader here.

 

Patient Forms

• Pre-Appointment Questionnaire

• New Patient Information Form

• Financial Policy

• Patient Arbitration Agreement

• Consent to Treat Minors

• Preventive Care and Cost Notice

• Phone and Text Consent Form

 

Imaging Forms

• Mammogram Packet

• Consent for Mammogram with Implants

• CT Patient History Form

• CT Contrast Consent Form

• DEXA Bone Density History Form

Medical Release Forms

• Release to REQUEST Medical Records

• Release to FORWARD Medical Records

• Imaging at Stockbridge Medical Release Form

• Mammogram Release Form

Access your healthcare information online

Patient Portal

Insurance Plans We Accept

Aylo Health participates in most insurance programs, including worker’s compensation. Below are some of the commercial insurances we accept. Visit our insurance page to view additional plans accept. Please note that benefits and coverage are specific to patient plans. We recommend contacting your insurance company to verify that our providers are in your network, ensuring that your office visits will be covered.

View Accepted Insurance