Save yourself time when you come in for your appointment by filling out the appropriate forms and bringing them with you.

Current Medication List Form

Health History Form

KAN Be Healthy Form

School Physical Form - English

School Physical Form - Spanish

NEW PATIENTS: Please fill out the following Demographic Form and bring it to your first visit.

ESTABLISHED PATIENTS: Please fill out the Demographic Form & bring it with you to your FIRST VISIT in a NEW YEAR. To better serve you, and to be compliant with federal regulations, we must update your information annually.

Demographic Form

Additional Forms

*** Must be updated annually ***

Acknowledgment of receipt of notice of Privacy Information

Hoxie Medical Clinic’s Privacy Information Form

Authorization for the release of your medical records to Hoxie Medical Clinic

If you are bringing your child in for a well-child exam, please click on the following link and on the left side of the page select, “BRIGHT FUTURES TOOL and RESOURCE KIT.” Select the appropriate age tool, open and print the correct “TOOL,” fill it out and bring it to your visit. (if you get a pop-up, just “cancel”)

Bright Futures Tool