Download Forms Below

Download Forms Below

For your convenience, we have made our forms and policies available below in PDF format. Feel free to print the forms, fill out the necessary information at home, and bring them with you on your next visit.

Medicare Wellness Forms

Questions Or Comments

If you have questions, want more information, or if you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also fill out the below form to request information.

If you wish to report a problem about the handling of your protected health information, you may contact the Physicians Immediate Care & Medical Centers (PICMC) Privacy Officer at:

You may also deliver a written complaint to the Clinic Director at our Family Medical Center facility, or file a complaint with the U.S. Secretary of Health and Human Services.