New Patient Forms



All new patients are required to complete the following forms. We recommend you download and print the PDF documents below. Then bring the completed paperwork with you to your first appointment.

Download
Imperial Health Disclosure Authorization Form
Disclosure_Authorization_Fillable.pdf
Adobe Acrobat Document 43.0 KB
Download
Download
Imperial Health General Consent for Care and Treatment
Imperial Health General Consent for Care
Adobe Acrobat Document 195.5 KB
Download
Download
Imperial Health Patient Authorization and Benefit Assignment Form
Patient Authorization and Benefit Assign
Adobe Acrobat Document 202.0 KB
Download
Download
Imperial Health Consent to Receive Text Messages or Emails about Appointment Reminders
Consent to Receive Appointment Reminders
Adobe Acrobat Document 292.2 KB
Download
Download
Imperial Health Notice of Privacy Practices
Notice of Privacy Practices_Fillable.pdf
Adobe Acrobat Document 401.6 KB
Download


First and Only in Southwest Louisiana
Services and Procedures
Patient Forms

CLOSED MONDAY & TUESDAY (Feb. 15th & 16th) DUE TO EXTREME WINTER WEATHER!