Pre-Visit Patient Forms

Complete your forms prior to your visit.

At Dr. J Express Care, we know that convenience is important to you. That’s why we make our patient intake, privacy and informational forms available to you prior to your visit.

Patient Privacy Forms

• Privacy and Billing Procedures – Dr J Express Care (PDF Version) – (HTML Version)
• Privacy and Billing Procedures – Dr J Express Care Spanish Version (PDF Version) – (HTML Version)

Patient Registration Forms

• Patient Registration Form – DR J EXPRESS CARE – (PDF Version) – (HTML Version)
• Patient Registration Form – DR J EXPRESS CARE – Spanish Version (PDF Version) – (HTML Version)

Medical Records Release Form

• Authorization to Release Protected Health Information (PDF Version) – (HTML Version)