Forms

Dakota Child and Family Clinic uses Practice Fusion for its electronic health record. This is a highly secure, cloud based program that allows Dakota Child and Family Clinic providers access to important health information when you call. To learn more about Practice Fusion go to www.practicefusion.com.

Our patient portal and online scheduling request features are a welcome convenience for our active patients. To set up your patient portal account call the clinic with an active email and phone number. To login into your existing patient portal account go to https://id.patientfusion.com/signin.

New Patients/First Appointment of the Year

Whether you’re new to our clinic or simply looking to make your appointment go quicker, listed below are copies of the forms you will be asked to fill out upon arriving at the clinic. You are more than welcome to print them off now and bring them with you instead.

Links beginning with an asterisk (*) are required for new patients only. All other forms are needed for new patients as well as established patients coming in for their first visit of the year.

2018 Registration

2018 HIPAA

2018 Health Care Home

2018 Financial Policy

2018 Adult Medical History

2018 Pediatric Medical History