What's New:

Forms

These forms are in PDF format and can be opened with Adobe Reader. You can click here to download Adobe Reader.

New Patient Information and Registration Forms

All new patients should bring the following three forms, completed, to your first appointment.

Financial Policy

Patient Registration Form

Medical History Forms:
   Adult, 18 and older
   Adolescent, 10-18
   Child, 10 and younger

Other Forms

If your child, 17 and younger, will be seen in the absence of a parent or guardian, sign and send the following form with them:
Consent to Treat a Minor

To request your medical records be sent from another provider to Kachina Family Practice:
Release of Records to Kachina Family Practice

To request your medical records be sent from Kachina Family Practice to another provider, or an Insurance company, or for any other reason:
Release of Records From Kachina Family Practice
(There is no charge for records sent directly to another provider, however, other records transfers may require a fee).