Forms

It is important that we, as your care providers, have available your complete medical history and other necessary contact information. Below we have a list of commonly used forms and notices that our practice are required to complete or acknowledge.

If you are visiting our office for the first time, our staff can outline which forms you will be required to complete upon visitation and you may wish to download, complete and bring them with you to save time. These forms are here to help you get the care you need.

New Pediatric Patient Forms

Consent to Treat Form

This Consent to Treat Form gives a physician permission to treat your child

Pediatric Initial Health Assessment

 

New Adult Patient Forms

Health Risk Assessment

This form gives a physician important information to help during consultation and offer the best preventive services

Patient Agreement

Patient History

Payment Agreement

Demographics

Activity Diet Assessment

Record Release

HIPPA

Care Rite News

  • Patient Portal +

    Accessing Your Medical Records Just Got Easier. The Patient Portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection. Using a secure username and password, patients can view health information such as: Should you need guidance with the Read More
  • Flu/ Pneumonia Shots +

    Get a Flu/ Pneumonia Shot - To Protect Someone Else. If you could take one simple step once a year that could prevent harm from coming to an infant, pregnant woman or elderly person, would you? You can by getting your annual flu vaccination. Influenza puts more than 200,000 Americans in the Read More
  • Childhood Vaccines & Flu Shots +

    Care Rite PLLC is able to provide childhood vaccines including flu shots for your child.We all want to keep our children happy and healthy, so immunizations administered at the correct time and kept up to date is important. Some vaccines are required before a child is able to attend school Read More
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Business Hours

Dyersburg Clinic

Mon - Fri  - 7:30 AM to 4:30 PM

Halls Clinic

Mon - Fri  - 7:30 AM to 4:30 PM

Ripley Clinic

Mon - Fri - 7:30 AM to 4:30 PM