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.

**NEW! Complete your request for Medical Records electronically. Click here to get started.**

Consent Forms:

Patient Caregiver Consent

Medical Release Forms:

Mammography Medical Release Authorization

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

New Psych Patient Form

New No Fault Form (Spanish Version)

Specimen Collection Instructions:

• Semen Sample Collection
• Sputum Sample Collection
• Stool Sample Collection
• Urine Sample Collection

Medicare Annual Wellness Forms:

Medicare Health Risk Assessment Form

Medicare Health Risk Assessment Form (Spanish Version)

Health Care Proxy