New Patient Forms

All new patients are required to complete the following forms. We recommend you download and print the PDF documents below. Then bring the completed paperwork with you to your first appointment.

Imperial Health Disclosure Authorization Form
Adobe Acrobat Document 43.0 KB
Imperial Health General Consent for Care and Treatment
Imperial Health General Consent for Care
Adobe Acrobat Document 195.5 KB
Imperial Health Patient Authorization and Benefit Assignment Form
Patient Authorization and Benefit Assign
Adobe Acrobat Document 202.0 KB
Imperial Health Consent to Receive Text Messages or Emails about Appointment Reminders
Consent to Receive Appointment Reminders
Adobe Acrobat Document 292.2 KB
Imperial Health Notice of Privacy Practices
Notice of Privacy Practices_Fillable.pdf
Adobe Acrobat Document 401.6 KB

First and Only in Southwest Louisiana
Services and Procedures
Patient Forms