Adult and Children Patient Forms | Valley Cares

Paperwork

Adult Patient Forms

Advance Healthcare Directive
Application Information
Insurance Employment Info
Letter of Revocation
Notice of Privacy Practices
Patient Questionnaire
Release of Information Form
Valley Rights and Responsibilities
Medicaid Eligibility
Self Pay Addendum
Medicaid Handbook

Children's Patient Forms

Application Information
Children Patient Questionnaire
COS Pamphlet
Medicaid Handbook
Privacy Policy (English)
Release of Information Form
Valley Rights and Responsibilities
School Medical History
Self Pay Addendum

Forms in Spanish

Patient Questionnaire
Release of Information Form
Notice of Privacy Practices
Valley Client Rights & Responsibilities

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