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Forms
Crystal Run provides online versions of commonly used forms for the convenience of our patients. Just fill out, print, and fax, mail, or bring the form you need for your next appointment.
Consent Forms:
Medical Release Forms:
Authorization for Crystal Run to Release Medical Information
Authorization for Crystal Run to Release Medical Information (Spanish)
Consent for Crystal Run to Release Pathology Slides/Block to Another Provider
Mammography Medical Release Authorization
Request for Medical Information to be sent to Crystal Run
Request for Patient Access to their PHI
Request for Patient Access to their PHI (Spanish)
Request for Amendment of Health Information
Notice of Privacy Practices:
Notice of Crystal Run Privacy Practices
Patient Health Questionnaires:
Patient Health Questionnaire_PHQ2-PHQ9 — (Spanish version)
Patient Health Questionnaire GAD-7 — (Spanish version)
Vanderbilt ADHD Parent Assessment Scale —(Spanish Version)
Drug Abuse Screening Test (DAST-10) (Spanish version)
Audit-C Questionnaire (Spanish version)
Registration Forms:
New Patient Registration Forms
Specimen Collection Instructions:
Medicare Annual Wellness Forms:
Medicare Health Risk Assessment Form
Medicare Health Risk Assessment Form (Spanish Version)