Patient Services

2021-2022 Influenza Vaccination

• Adult Consent Form (PDF)
• Ages 6 months through 18 years Consent Form (PDF)

Central Registration Patient Forms
Please complete these forms and bring them with you to your appointment. These forms are required for all appointments within LRH’s Medical Office Building.

• Consent Form for LRH Clinics, Urgent Care and Ancillary Departments (PDF)
• Permission of LRH to Discuss Treatment Information with Family, Friends, and Other Designated Individuals (PDF)
• LRH Central Registration Form (PDF)