Valerie Jacobson, MD
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:
Initiates your request to have your medical records sent to another medical provider and/or to request your medical records from another provider be sent to your primary care doctor.
Authorizes Baptist Primary Care to leave appointment, referral and test results information on your answering machine.
Authorizes Baptist Primary Care to release information concerning the status of your health care, including laboratory and radiology results and to discuss your treatment plan with an individual that you name.
Captures patient demographic information, insurance information and authorizes Baptist Primary Care to prepare and submit your medical bill directly to your insurance company.
Requires Adobe® Acrobat Reader or Apple® Preview application. Click [ HERE ] to download and install the latest version of the Adobe® Acrobat Reader. Once you have the reader installed, you will be able to open and print the selected form.