We make our forms available online 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.

Patient Registration

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 Forms link for additional information.

In collecting demographic information, ARC adheres to the standards that were established by the U.S. Office of Management and Budget (OMB) in 1997. It is the same standard used by the U.S. Census Bureau. The OMB requires five minimum categories for data on race:

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Native Hawaiian or Other Pacific Islander
  • White

The OMB requires two minimum categories for data on ethnicity: 

  • "Hispanic or Latino"
  • "Not Hispanic or Latino”

A patient's response to the race and ethnicity questions are based on self-identification and the patient may choose more than one race.

MyChart® Registration & Caretaker Forms

MyChart® is ARC's easy-to-use patient portal that allows quick and easy access to you and your loved one's ARC health information anywhere and anytime. Visit the MyChart® Registration & Caretaker Forms page for more information on how you can sign up for MyChart® and how to also gain access to your child or loved one's medical information.

Patient Information and Consent for Treatment of a 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

Whether you are a new patient requesting a transfer of your medical records to Austin Regional Clinic or an established patient requesting your medical records from ARC, a Release of Information Form is required. Please visit the Release of Information page for more information and to find the ROI form that best suits your needs. 

Primary Care Forms

Pediatric Health History

If your child is a new patient at ARC, please complete the associated form under Pediatric Health History and give it to the doctor or nurse at the first visit. This form asks for information about the child's health, including major illnesses, immunizations, and injuries.

Adult Health History

If you are a new patient at ARC, please complete the Adult Health History Form and give it to the doctor or nurse at the first visit. This form asks for information about your health, including major illnesses, injuries, and surgeries, as well as family health history.

Medicare Wellness Visit Forms

If you are a Medicare patient 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.

Specialty Forms

Allergy & Asthma Patient Forms

If you are a new patient with ARC Allergy & Asthma, please complete the Allergy Health History Form and mail it back to your allergist's office prior to your first visit.

Dermatology Patient Forms

If you are a new patient with ARC Dermatology, please complete the Dermatology Health History Form and give it to the doctor or nurse at your first Dermatology visit.

Endocrinology Patient Forms

If you are a new patient with ARC Endocrinology, please complete the Endocrinology/Infertility Health History Form and give it to the doctor or nurse at your first Endocrinology visit.

Gastroenterology Patient Forms

If you are a new patient with ARC Gastroenterology, please complete the Gastroenterology Health History Form and give it to the doctor or nurse at your first Gastroenterology visit.

General Surgery Patient Forms

If you are a new patient with ARC General Surgery, please complete the General Surgery Health History Form and give it to the doctor or nurse at your first General Surgery visit.

Infertility Patient Forms

If you are a new patient with ARC Infertility, please complete the Endocrinology/Infertility Health History Form and give it to the doctor or nurse at your first Infertility visit.

Ob/Gyn Patient Forms

If you are a new patient with ARC Ob/Gyn, please complete the Ob/Gyn Health History form and give it to the doctor or nurse at your first Ob/Gyn visit.

Orthopedic Patient Forms

If you are a new patient with an ARC Orthopedist, please complete the Orthopedic Health History form and give it to the doctor or nurse at your first orthopedic visit.

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.

Podiatry Patient Forms

If you are a new patient with ARC Podiatry, please complete the Podiatry Health History form and give it to the doctor or nurse at your first Podiatry visit.

Rheumatology Patient Forms

If you are a new patient with ARC Rheumatology, please complete the Rheumatology Health History form and give it to the doctor or nurse at your first Rheumatology visit.

Service Forms

Travel Medicine Patient Forms

If you are a new patient with ARC Travel Medicine, please complete the Travel Medicine Health History form and give it to the doctor or nurse at your first Travel Medicine visit.

Weight Management Patient Forms

If you are a new patient with ARC Weight Management , please complete the Weight Management Health History form and give it to the doctor or nurse at your first Weight Management visit.