Due to our current patient load and the high volume of new patient inquiries, we are currently prioritizing the acceptance of children and household family members of current patients.

If you are interested in joining the practice, please complete the appropriate registration form: Adult New Patient Registration form (18 and over) Please note, the submission of a registration form does not guarantee acceptance, but we will review all inquiries and reach out if we are able to accommodate you as a new patient. Thank you for your understanding!

Child Registration Packet

Interested in becoming a patient?

Due to our current patient load and the high volume of new patient inquiries, we are currently prioritizing the acceptance of children and household family members of current patients.

If you are interested in joining the practice, please complete the appropriate registration form: Child New Patient Registration form (under 18) Please note, the submission of a registration form does not guarantee acceptance, but we will review all inquiries and reach out if we are able to accommodate you as a new patient. Thank you for your understanding!

Authorization for Disclosure of Medical Information

This specific form authorizes us to send your records to another practice. For example, if you are moving and need us to send your records to a new practice, or are seeing a specialized doctor and they need to see your medical history, fill out the information of where you want the records to be sent. Please note: there is a fee to disclose records to yourself. We ask for 30 days notice to send medical records.

Medical Disclosure Form

Authorization To Obtain Medical Information

This specific form authorizes us to obtain your records from your previous provider. For example, if you are new to Atkinson Family Practice, fill this form out and we can obtain your records from your old practice. To access the Authorization for Release of Medical Information form, click on the link below.

Medical Release Form

TMS Forms

Please email here if you have any questions about the forms below.

Please fill out either of the forms below to see if you are qualified for treatment.

TMS Patient Intake Form or NeuroStar TMS Referral Form

Please fill out the following forms before your appointment:

Adult Registration Packet

Patient Consent For A Medical Practice

1 Year Follow-Up Study Article

Patient Health Questionnaire Form

Patient Expectations at Atkinson Family Practice

Patients accepted to AFP understand the value of our Medical Home. We promote health as a priority, despite our busy lives. However, we cannot offer quality medical care without seeing you. For this reason we will terminate patients from the practice for any of the following reasons:

- No-show/late cancel for 3 appointments

- No-show/late cancel for 2 Physical Appointments

- Breach of our Code of Conduct

- Non-compliance with our treatment plan

Forms and Policies