Downloadable Forms

For registration at The Baton Rouge Clinic, AMC

• PATIENT REGISTRATION FORM
• URGENT CARE PATIENT REGISTRATION FORM
• BRC CREDIT POLICY

Release of Protected Health Information:

• HIPAA PRIVACY NOTICE
• RELEASE FROM THE BATON ROUGE CLINIC, AMC
• RELEASE TO THE BATON ROUGE CLINIC, AMC

For the release of Medical Records
Phone: (225) 246-9770
Fax: (225) 246-9209

These forms are part of a child’s comprehensive assessment for ADD/ADHD.

• NICHQ TEACHER ASSESSMENT
• NICHQ PARENT ASSESSMENT
• NICHQ TEACHER FOLLOW UP
• NICHQ PARENT FOLLOW UP

• MYCHART ADULT PROXY FORM
• MYCHART TEEN PROXY FORM
• MYCHART CHILD PROXY FORM

The form to bring to COVID-19 Vaccine Appointments.

• • COVID-19 VACCINE CONSENT FORM

Instructions for before and after procedures and brochure overview.

• COSMETIC SERVICES BROCHURE
• PRE PROCEDURE BBL
• POST PROCEDURE BBL
• PRE PROCEDURE LASER HAIR REDUCTION/REMOVAL
• POST PROCEDURE LASER HAIR REDUCTION/REMOVAL
• PRE PROCEDURE LASER RESURFACING
• POST PROCEDURE LASER RESURFACING
• PRE PROCEDURE MICRO LASER PEEL
• POST PROCEDURE MICRO LASER PEEL
• PRE PROCEDURE PROFRACTIONAL
• POST PROCEDURE PROFRACTIONAL
• SCLEROTHERAPY PATIENT INSTRUCTIONS

Surgery forms recommended by our doctors.

Breast Cancer:

• • History Form
  • Breast Cancer Risk Assessment Form

General forms as recommended by our doctors.

• BONE DENSITY QUESTIONNAIRE
• MAMMOGRAM QUESTIONNAIRE
• SLEEP QUESTIONNAIRE

Questions, surveys and authorization forms.

• MRI PATIENT INSTRUCTIONS
• MRI SCREENING HISTORY AND QUESTIONNAIRE FORM

Paper application for employment

• APPLICATION FOR EMPLOYMENT