Patient Forms

Oncology Patient Forms

Upload and print these forms prior to your visit with us at the Charach Cancer Treatment Center. This are required for patient check in. 

Click here for .pdfs of all the forms listed below.

Acknowledgement of Advance Directive for Health Care - this form is required to be completed annually and confirms that you have completed an Advance Directive for Health Care.

New Patient Information - this form enables you to list health-related information that helps our clinical staff with your care.

New Patient Medication List - this form asks that you list all current medications you are taking, including vitamins, supplements and over-the-counter medications.

Outpatient General Consent Form - this is a required, standard form that gives consent by you for us to provide outpatient care and services.

Patient Communication Information - this form is a request for standard contact information like phone numbers, address, etc. 

Pharmacy Information and E-Prescribe Release Form - this form provides you with opportunity to enroll in our E-Prescribe program, which enables our pharmacists to send your prescription orders electronically to your preferred pharmacy.

 

 

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Patient Forms