Registration Forms

medical-form

Thank you for your interest in CFG. We understand and appreciate the trust and confidence you are placing with our organization. You can count on our professional staff to provide the assistance you need.

For patients who are minors

The following form must be completed prior to scheduling an appointment. The completed form can be faxed to 856-797-4775 or emailed to intake@cfgpc.com.

Consent for Treatment of a Minor (WORD)

 

For all patients

Please complete and sign the forms below and bring them with you to your appointment or you can fax them to 856-797-4775. If you cannot print & complete the forms prior to your appointment please arrive 15 minutes early the day of your appointment to complete them at our office. We will also need to make a copy of your insurance card, so please bring it with you to your appointment.

New Patient Registration Form (PDF)

Patient Background Form (PDF)

Notice of Privacy Form (PDF)

Cancellation Policy (PDF)

Acknowledgment of Receipt Form (PDF)

Informed Consent for Treatment (PDF)

Patient Education Sheet (PDF)

Authorization for Medical Professional to Make Appointment on Patient’s Behalf (WORD)