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Patient Request for Health Information Form

Use this form to request access to your health information.

Patient Verbal Consent

Patients will no longer be signing an electronic consent when registering for their appointment. They will instead be asked to provide verbal consent to: (1) release their information for treatment, payment, and operations purposes; assign their benefits; contact their cellular phone; and acknowledge the Patient Bill of Rights and Notice of Privacy Practices information.

This verbal consent form provides the details of that consent.

Pharmacy Fees

Current, standard pharmacy charges at Lakewood Health System. Prices are current as of 1/1/2019 and are subject to change.

Proxy Consent Form for Routine Care

Proxy Consent for Routine Care form allows Lakewood to provide routine medical care for patients.