Below are the documents necessary for enrollment in the practice. You may click on the document link to download and print it.
Please note: all Medicare patients and those who will be on Medicare within the next 12 month period are required to sign 2 different contracts.
- Patient Services Agreement Final.PDF
Patient Agreement for All Patients
- CLIM Notification Form PDF.pdf
Patient Notification and Demographic Form for all patients
- MEDICARE PRIVATE CONTRACT PDF 2017.pdf
Medicare Required Contract for patients aged 63 and older
- CLIM Enrollment Form PDF.pdf
Clear Lake Internal Medicine Enrollment Form PDF
- Patient Information Sheet PDF.pdf
Patient Demographic/Insurance Form
- New Patient Medical History Questionaire.pdf
New Patient Medical Questionnaire