Riverside Forms, Policies & Screening Documents
On this page, you will find documents that make it easy to get the help and service you need. In some cases, we offer two different ways to access and complete a form.
- E-Sign: Complete the forms electronically using Adobe Sign. Fully completed documents are submitted electronically to the team at Riverside Medical Group.
- PDF: Print and fill out the form. Please share completed patient forms with your provider’s office.
New Patient Forms
Adult Patient Forms
English Forms
- Adult New Patient Registration Packet(opens in new window)
- Notice of Privacy Practices(opens in new window)
- Acknowledgement of Financial Responsibility(opens in new window)
- Adult New Patient Registration(opens in new window)
Formulario en Español
Pediatric Patient Forms
English Forms
- Pediatric New Patient Registration Packet(opens in new window)
- Notice of Privacy Practices(opens in new window)
- Acknowledgement of Financial Responsibility(opens in new window)
- Pediatric New Patient Registration(opens in new window)
Formulario en Español
Riverside Policies & Screening Forms
Screening Forms
English Forms
- Adult Medical History Form(opens in new window)
- Adult Cancer History Form(opens in new window)
- Adult Depression and Alcohol Questionnaire(opens in new window)
- Pediatric Newborn Questionnaire(opens in new window)
Formularios en Español
Sleep Medicine Forms
Adult Patient Forms
English Form
Sleep Medicine Adult Consult(opens in new window)
Formulario en Español
Sleep Medicine Adult Consult(opens in new window)
Pediatric Patient Forms
English Form
Sleep Medicine Pediatric Consult(opens in new window)
Formulario en Español
Sleep Medicine Pediatric Questionnaire(opens in new window)
Co-pay Policy
All co-pays in accordance with your insurance benefits policy must be collected at the time of service, including co-pays that are required for follow-up sick visits and visits to refill chronic medication.
Patient Balances
Make a payment today by contacting our billing department at 551-257-7030 or use our convenient online payment portal (opens in new window).
Record Release Form
If your records are at a different practice and you would like to join Riverside Medical Group, please complete the Patient Record Release Form(opens in new window) and send it to the Office Manager at the office that you visit.