Harwer M.D. Partners in Health

Standard Forms


Advanced Beneficiary Notice
Welcome Sheet English
Fax Sheet New Patient
Welcome Sheet Spanish
Arbitration Agreement
HIPPA Form
Credit Card Payment Form
Acuerdo de Arbitraje
Arbitration Message
Contact Us Form
POLST Form English
POLST Form Spanish
QUEST Labs Locations
Travel Consult p1
Travel Consult p2
Travel Consult p3
New Patient Information


Occupational History Form
Adult Medical History Form
Adolescent Medical History

Adolescent 12 - 15 years
Adolescent 15- 17 years
Past Medical History

Toddler Care 18 - 24 months
Child Care 2 - 3 Years
Child Care 3 - 4 Years
Child Care 4 - 5 Years
Child Care 5 - 6 Years
Child Care 6 - 9 Years
Pre Adolescent Care 9 - 11 years
Infant Care 2 wks - 2 months
Infant Care 4 - 6 months
Infant Care 9 - 12 months

Newborn Care
Pediatric / Adolescent Medical History
Adolescent Care 12 - 15 years
Adolescent Care 15 - 17 years
Preadolescent Care 9 - 12 months
Toddler Care 15 - 18 months
Toddler Care 18 - 24 months
Immunization Schedule 2009
School Authorization Meds

Authorization to share medical info
Predesignation of Personal Physician

Quest Laboratory locations
Insomnia form
Restylane Consent p1
Restylane Consent p2
Occupational history
Laser Nail Fungus Treatment Consent
Laser Resurfacing consent
Laser Deposit
Laser Hair Removal Consent
Prepare for Laser Hair Removal
Laser Hair pretreatment instructions
Laser Hair Instructions 2
Laser Vein Consent p1
Laser Vein Consent p2
Laser Vein Consent p3
Laser Vein Pretreatment Instructions
Laser Rejuvenation Instructions
Laser Rejuvenation Consent
Laser Consent p1
Laser Consent p2
Laser Consent p3
Laser Consent p4
BLU-U Treatment Instructions
Headache Quiz

Adult ADHD-RS-IV
Form
Are You Living with Adult ADHD
ADHD Letter to Parent

ADHD Parent Questionnaire p1
ADHD Parent Questionnaire p2
ADHD Parent F/U visit 1
ADHD Parent F/U visit 2
ADHD Form Teacher F/U Visit p1
ADHD Form Teacher F/U Visit p2
ADHD Form Teacher F/U Visit p3
Release of Medical Records

Consent in English
Consent in Spanish
Authorization To Treat Minor
Animal Bite Form

Blood Glucose Journal

Employers Authorization to Treat
Mood Questionnaire p1
Mood Questionnaire p2
Mood Questionnaire p3
Mood Screen
Sleep Scale
MVAccident Form
NASD Alcohol Screen
Birth Control Options
Release of Medical Records