Forms

New Patient Registration Packet

If you are a new patient of ours, we welcome you to fill out the necessary paperwork ahead of your appointment. (This really speeds up your check-in at the time of your appointment and can help you see your doctor even faster!)

Submit Securely Online:

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PATIENT CHECKLIST

A photo of an "Ask the doctor" worksheet and checklist

Need a worksheet to track your medications or make notes for your doctor?

Download this handy patient checklist and bring it with you before seeing your doctor at your next appointment!
(English Worksheet)
(Spanish Worksheet)

Or, fill out an electronic version to send to your personal email account to keep track of, try it HERE.

Sliding Fee Application

We are so happy to offer a sliding fee discount program to eligible individuals based on the patient’s ability to pay.  Ability to pay is determined by the household size and annual income relative to a discount schedule based on federal poverty income guidelines.

If you would like to apply, please fill out the following application:

Submit Securely Online:

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2024 Sliding Fee Rate Card – English

2024 Sliding Fee Rate Card – Spanish

3rd Party Release of Health Information

If you would like a 3rd party to be given the permission/ability to discuss your healthcare with our staff, please fill out the following form. (Note: If you are a new patient, this form is already included in your registration packet.)

Submit Securely Online:

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Authorization to Release Health Information

Unlike the 3rd party release form, the Authorization to Release Health Information form is a form that releases health information from your medical record; whether that be to someone in your family or another medical institution. (Note: if you are a new patient, this is not included in your patient registration packet.)

Submit Securely Online:

Print at Home:

Revocation of HIPAA Authorization For Use, Disclosure, and Access to Protected Health Information (PHI)

You have the right to revoke or take away permission to disclose or share your health information. Completing this form, you are revoking permission for Full Circle Health to disclose or share your health information with named individuals and/or entities.

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APPOINTMENTS:

Ada County Clinics: (208) 514-2500
Canyon County Clinics: (208) 514-2529

If you believe you are having a medical emergency, call 911 immediately.

AFTER HOURS CARE

Call any of our Full Circle Health location phone numbers to speak with a Registered Nurse for help in answering your health related questions, even after our clinics have closed. Follow the simple prompts provided to you once you’re on the call.

PATIENT WELCOME BOOKLET

Click the page below to view a comprehensive booklet to help you navigate our healthcare system. Pages include locations, extended hours, a list of our services, pharmacy details, and so much more!

Spanish Patient Welcome Booklet

SIGN UP FOR MYCHART!

With MyChart, you can:

  • Communicate with your healthcare provider.
  • Request and cancel appointments.
  • Request prescription refills.
  • View and pay your bill.
  • Update your personal information
  • Review your after-visit summary, test results, medications, immunization history, and more.

Sign In
Learn More