Forms
We are committed to getting you in and out of your appointment as efficiently as possible. If you are a new patient, please fill out all five English/Spanish forms below and email them to amedical@avenue360.org.
Patient Rights & Responsibilities
—Derechos y Responsabilidades del Paciente
Patient Prescription Medication Consent
—Consentimiento de Recetas Electronicas
—Authorizacion para Divulgar Information de Salud
—Informacion sobre Ingresos y Seguros
Telehealth at Avenue 360
To telehealth patients: Please fill out the forms above and this additional one:
COVID-19 Vaccine
Consent and Screening Form for COVID-19 Vaccine
Forma de Consentimiento y Revisión para la Vacuna del COVID-19