We make our forms available on-line to facilitate and expedite your visit to our offices.
Please click on the links below or on the left for additional instructions on the form and how and when to return it.
General Patient Forms
The Patient Registration process and subsequent form provides us with the information to set up your billing account with ARC. Information required includes demographics of each patient, responsible part for payment, and any health insurance information applicable to the patient. This form is required for all new patients to ARC, please refer to our Patient Registration link for additional information.
MyChart Registration & Proxy
Thank you for your interest in MyChart®, an easy-to-use internet tool that provides you quick and secure online access to your Austin Regional Clinic health information from anywhere at any time. To register for access to your health information in MyChart® or to register for proxy access to your loved ones' health information in MyChart®, please complete the appropriate MyChart® form(s).
Patient Information and Consent of Minor
If you are the parent of a minor and would like your child to be seen by any of our providers without your presence, please fill out a Consent to Medical Treatment of a Minor form and have your child bring it to the appointment.
Release of Information (ROI) Forms
We have two different ROI forms for your use.
- If you are an established patients and want to transfer your ARC Patient Records TO a Non-ARC Physician
- If you are a new patient and want to transfer your patient records FROM a Non-ARC Physician TO an ARC Physician
Visit our Release of Information page for more of these forms.
Adult Health History
Please complete the Adult Health History Form and give it to the doctor or nurse at your visit. This form asks for information about your health, including major illnesses, injuries, and surgeries, as well as family health history.
For your convenience, and to help you save time during your appointment, please download and complete the Dermatology patient forms. Please bring the completed forms with you to your consultation.
Medicare Wellness Visit Forms
If you are a Medicare patients and you have an appointment scheduled for a Medicare Wellness Visit, Medicare requires that you complete a new Medicare Wellness history form. We also provide advance directive forms that we recommend you fill out and keep on record with your ARC physician. Advance directives are legal documents that allow you to convey your decisions about end-of-life care ahead of time. They provide a way for you to communicate your wishes to family, friends and health care professionals, and to avoid confusion later on.
Orthopedic Health History
Pain Medicine Patient Forms
For your convenience, and to help you save time during your appointment, please download and complete the Pain Medicine patient forms. Please bring these completed forms to your appointment or be prepared to arrive approximately 45 minutes before your scheduled appointment time to complete them before your appointment.
Pediatric Health History
Please complete the Pediatric Health History form and give it to the doctor or nurse at your child's visit. This form asks for information about the child's health, including major illnesses, immunizations, and injuries.
Patients will have to fill out physical therapy patients forms also available in en español below prior to the first physical therapy visit. Please bring these with you already completed or be prepared to arrive approximately 15 minutes before your scheduled appointment time.