new patients
Take Your First Steps Toward End-of-Life Care
We’re delighted to welcome you to our practice. To ensure we have all the necessary information to provide the best possible care, we kindly ask that you complete the new patient forms.
New Patient Forms
These forms are designed to help us understand your health history, current health status, and any specific needs or concerns you may have. Autonomy Health will email you these forms.
New Patient Registration Form
Consent to Release Information Form (HIPAA Consent Form)
End of Life Decision-Making Form
Medical History Form
If you have any questions or need assistance with the forms, please don’t hesitate to contact us at (619) 786-8222
Patient Privacy and HIPAA
Safeguarding Your Privacy: Our Commitment to HIPAA
At Autonomy Health, we deeply respect and value your privacy. We understand the importance of protecting your personal health information and take that responsibility seriously.
In accordance with the Health Insurance Portability and Accountability Act (HIPAA), a federal law designed to safeguard your health information, we maintain stringent privacy and security practices. This means any information about your health status, the health care you receive, or the payment for such healthcare that can be linked to you is kept confidential.
Our practice follows all HIPAA guidelines to ensure your information is protected. This includes requiring your written consent before sharing any health information, using secure systems to store your information, and educating our staff about maintaining your privacy.
Rest assured that your privacy is our priority.
Patient Forms
Whether you're seeking guidance for yourself or a loved one, we’re here to provide compassionate support and answer any questions you may have. Please fill out the form below, and we’ll be in touch as soon as possible.
