Jonathan Balog, DO Office and Other Patient Information
Welcome to Baptist Primary Care. To help expedite your first visit, we provide our health forms online so that you can print and complete them at your convenience. If you have any questions, please don’t hesitate to contact our office staff.
Baptist Primary Care Forms
Advance Directives Information
Baptist Health encourages all patients to discuss future healthcare decisions with family and health care providers. That's why we offer advance care planning resources and tools, actionable next steps and forms to help you plan your care if ever faced with a serious or life-limiting illness.
Authorization for Use of Voicemail
Authorizes Baptist Health to leave appointment, referral and test results information on your voicemail.
BPC Patient Registration and Authorization
Captures patient demographic information, insurance information and authorizes Baptist Primary Care to prepare and submit your medical bill directly to your insurance company.
Provides your primary care physician with important information about your medical and family history to better diagnose, treat or prevent conditions.
Medical Records Release
Request to have your medical records sent to another medical provider.