Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.
"I am a senior male who has seen his share of physicians in this lifetime. The experience so far from Dr. Hallbauer and his associates has been nothing short of extraordinary. Friendly, skilled, and compassionate care from day one has been refreshing. His team works to insure your visit is positive."
Family Medicine Associates Of Conroe – Patient Packets
In an effort to help appointments run smoothly we ask that you please print and complete a patient packet prior to your appointment. These will be requested at check-in. We appreciate your cooperation.
If you would like to complete your paperwork electronically, please email info@conroefamilymed.com and we will send you over your forms via Docusign.
Bright Futures Previsit Questionnaires
Patient Forms
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Office Policies
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)
Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)
