Our goal is to make your process as simple as possible. Below are links to some of our most common patient forms and instructional handouts. Feel free to view, download, print and fill them out whenever it’s convenient for you.
Medication & Health Forms
Privacy Forms
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Assignment of Benefits Financial Responsibilities and Disclosure of Protected Health Information
Download Form
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Acknowledgement of Receipt of Notice of Privacy Practices Form
Download Form
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Patient Right to Access Records Form
This form is for patients requesting a copy of their information whether for themselves, for another provider or for a family member or friend.
Patient Request for Access Form
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Important Notice
Please take note that over the coming weeks, CCK will be transitioning to an updated electronic medical record system in order to better serve our patients. Thank you in advance for your patience and understanding with our team as they manage this change while continuing to care for you.
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