Center For Family Medicine Forms

The Center for Family Medicine is happy to provide the following useful information available for download for our patients who are anticipating procedures at our center. These documents are provided for convenience. If you have any questions, please contact us.

Bone Density

Bone mineral density (BMD) questionnaire.

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Medical Records

Authorization for records release.

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Notice of Privacy Practices

Privacy Practice Notification Form

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Office and Financial Policy

Office and Financial Policy.

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New Patient Paperwork Adults

New adult patients please fill out this form before your visit.

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New Patient Paperwork Minors

New minor patients please fill out this form before your visit.

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Additional Downloads - Exercises, Procedures and Conditions

Additional materials for Patients

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Center For Family Medicine Accepted Insurance

The Center for Family Medicine is happy to provide our list of accepted insurance for our patients who are anticipating services at our center. If you have any questions, please contact us.

  • AARP *
  • Administrative Concepts
  • Aetna
  • Assurant Health

  • Blue Cross Blue Shield **

  • Care Improvement
  • CBA
  • Century Health Care
  • Cigna
  • ChampVA
  • Dallas General
  • Federated Isurance
  • First Health
  • GEHA
  • Golden Rule
  • Great West
  • Group & Pension
  • Hammerman & Gainer
  • HCH Administrators
  • Health First
  • Health Smart
  • Humana
  • JP Farley
  • Mail Handlers
  • Medicare***
  • NALC
  • New Era

  • PAI

  • Pan American Life
  • PCIP
  • PHCS
  • Philadelphia American Life
  • Physician Mutal
  • Reserve National Insurance
  • RSL Specialty
  • Select Benefit
  • Smith Administrators
  • Standard Life & Casualty
  • Starkmark
  • TML

  • United Healthcare (UHC)

* Including Secure Horizions HMO
** Including Health Select HMO
*** Subject to physicians accepting new Medicare Patients and Guidelines