Forms

Our Registration Package makes it easy to be new here!

We are delighted to welcome you to the Riverside family. Please find set out below our New Patient Registration Package and our Record Release Forms.

For all Patients

  1. Riverside General Information Packet (Also available in Spanish)
  2. Riverside Notice of Privacy Practices (Also available in Spanish)
  
For Our New Adult Patients

  1. Adult New Patient Welcome Letter (Also available in Spanish)
  2. Adult New Patient Registration Forms (Also available in Spanish)
  3. Adult Medical History Form (Also available in Spanish)
  4. Adult Cancer History Form (Also available in Spanish)
  5. Adult Depression and Alcohol Questionnaire (Also available in Spanish)
 For Our New Pediatric Patients

  1. Pediatric New Patient Welcome Letter (Also available in Spanish)
  2. Pediatric New Patient Registration Forms (Also available in Spanish)
  3. Pediatric Newborn Questionnaire

 

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

All patient balance are due within 30 days of services rendered. Please contact our billing department at 551-257-7030 to make your payment today!

Record Release Form

If your records are at a different practice and you would like to join Riverside Medical Group, please complete this form and send it to the Office Manager at the office that you visit.

Click here for a copy of our Patient Record Release Form.

 

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