PATIENT FORMS
NEW PATIENTS
Thank you for choosing Arroyo Vista Family Health Center as your Primary Care Provider! We look forward to helping you and request that you print and complete the forms below and bring them to your first visit. You can print the New Patient Packet and complete it accordingly. Please give us a call if you have any questions (323-987-2000)
Existing Patients
Get a head start on your paperwork and Update your information before your next appointment
Registration form ( Annual Update) (Spanish PDF)
Privacy Consent (Update every Three years)
Adult Health History (Required for Complete Physical Exams)
Depression Screening (Required for Complete Physical Exams) (Spanish PDF)
TB Screening Questionnaire ( Annual update - Required for Complete Physical Exams) (Spanish PDF)
Adult Vaccine screening (Annually) (Spanish PDF)
Health Literacy Assessment ( Annual assessment) (Spanish PDF)
Self-management goal ( Diabetic population) (Spanish PDF)
Arroyo Vista Family Health Center’s patient self-reported blood glucose log (Spanish PDF)
Arroyo Vista Family Health Center’s patient self-reported blood pressure log (Spanish PDF)
Pediatric Patients
Adult Complete Physical Packet Breakdown (English & Spanish)
18-64 Years, Adult Health History form, PRAPARE assessment, Drug abuse screening form Adult CPE packet.pdf (Spanish PDF)
65+ Adult Health history form, PRAPARE assessment, Drug abuse screening form Adult CPE packet.pdf (Spanish PDF)
Packet Breakdown (English & Spanish)
0-6 month- Vaccine Questionnaire, 0-6 months (SHA)- Nutrition Form Patient Packet (0-6months).pdf
7-12 months - SHA ( 7-12 months) Nutrition form, Vaccine Questionnaire Patient Packet (7-12 months).pdf (Spanish PDF)
1-2 Year- SHA, Nutrition form, Vaccine Questionnaire, MCHAT-R, Blood lead screening Patient Packet( 1-2yrs ).pdf (Spanish PDF)
3-4 years – SHA, Nutrition form, Vaccine Questionnaire Patient Packet ( 3-4 yrs).pdf (Spanish PDF)
5-8 years- SHA, Nutrition, Vaccine Questionnaire, Child lead poisoning evaluation Questionnaire Patient Packet ( 5-8 yrs).pdf (Spanish PDF)
9-11 years- SHA, Nutrition form, Vaccine Screening Patient Packet ( 9-11 yrs).pdf (Spanish PDF)
12-17 years- SHA, Nutrition form, Vaccine screening, PHQ-9A, SCD screening Patient Packets (12-17 yrs).pdf (Spanish PDF)
PATIENT FORMS TO DOWNLOAD OR COMPLETE ONLINE
By clicking on the links above, you can access and complete any forms needed for your upcoming visit. You have two options for filling out the forms:
Option 1: Download and Print
You may download and print the form from your computer. Fill it out by hand and bring it with you to your next scheduled appointment.
Option 2: Fill Out Electronically
Most forms are enabled for electronic completion. To do this:
- Download the form to your computer
- Type your responses directly into the form
- Save the completed form
You may then:
- Email the form to: Healthinformation@arroyovista.org
- Or print it and bring it with you to your appointment
Important: When submitting forms by email, please include the following information in the body of your message:
- Your first and last name
- Your date of birth
- Your scheduled appointment date
- The type of appointment (e.g., physical exam, follow-up, new patient, etc.)
This helps us correctly match your form to your visit and avoid delays.
Coming to the Clinic?
Printed forms are available at all clinic locations. However, we strongly encourage patients to complete forms in advance. If completing forms on-site, please arrive early to allow time before your appointment.
For Forms Requiring a Provider’s Signature:
Please complete your portion of the form before your appointment.
Important Notes
- Please ensure the appointment date entered on the form matches your scheduled appointment date (Date of Service).
- If you reschedule or cancel your appointment, you will need to update and resubmit the form with your new appointment date. This ensures our clinical team has the most accurate information for your visit.
If you have any questions or need assistance, please call our front desk or contact us through the patient portal.