Patient Forms
Forms and helpful resources to help you save time and stay healthy.Here you’ll find a number of Primary Care Associates of Appleton’s most-commonly requested patient forms in an electronic version.
PRIMARY CARE ASSOCIATES OF APPLETON FORMS
Request for Release of Medical Records
MyChart proxy access request for minor patient
MyChart proxy access request for adult patient
Confidential Channel Communication Request (Patient-Authorized Methods of Communication)
Form Completion Request
Power of Attorney for Delgating Parental Power for Health Care (Medical Treatment Consent for Minors)
Medical History Form (for patients of Dr. Johnston-Rickert)
Past Medical History Form (for Internal Medicine patients)