Solace Cancer Care | Dr. Philben's New Patient Forms

Dr. Philben's New Patient Forms

For your convenience, below are five forms that each new patient must complete. You can download them and complete them from the comfort of your own home to save time at your visit to our office.

We know it's a lot of paperwork, but it is necessary to provide your care and most of it is required by law.

If you have any questions, please call us at 530-244-2223.

A Medical History and Physical Form

Thank you for choosing our office. In order to serve you properly we will need the following information. All information will be held confidentially.

Download Solace Medical History and Physical Form »

Solace New Patient Request Form

Thank you for choosing our office. In order to serve you properly we will need the following information. All information will be held confidentially.

Download Solace New Patient Request Form »

Authorization for Use or Disclosure

By downloading, completing and returning this form to Solace Cancer Care, you give us permission to share your health information with other health care providers who need it to help us in your treatment.

Download Authorization for Use or Disclosure »

Individual Health Information Consent Form

This document will give Solace Cancer Care your permission to use and disclose your health information for treatment, payment, and/or health care operations.