How to Complete Your Forms
New patients: Start with Consent for Wound Care Treatment below. After you submit each form, the next form opens automatically. There are eight forms, and the last one ends with a confirmation and next steps.
Only need one form? Choose it below. Each form is submitted separately. Use Return to Form List to choose another form, or Back to Website Home to leave the forms. Submit your current form before leaving to send your answers.
Patient Forms
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Consent for Wound Care Treatment
Review the consent for routine wound care and discuss any questions with your care team before signing.
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HIPAA Privacy & Authorization
Review PNW’s privacy practices and complete the authorization choices for how your health information may be used or shared.
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Home Environment Safety Consent Form
Review home-visit safety expectations and share information about your care environment that may help us prepare for a visit.
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Consent for Wound Photography
Review how wound photographs may be used for clinical documentation and provide your consent as applicable.
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Financial Responsibility Agreement
Review the agreement outlining financial responsibilities and billing expectations for your care.
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Insurance Information
Share your insurance details so our team can review coverage information and coordinate billing.
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Authorization to Share Medical Information
Choose the people or providers you authorize PNW to communicate with or share relevant medical information with.
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Patient Safety Notice & Acknowledgment
Review an important patient safety update and information about a drug-resistant germ called CRAB. Confirm receipt and let us know if you would like a call, a paper copy, or help reviewing the information. This acknowledgment is separate from consent to treatment.