Made Simple, Secure, & Designed for Your Convenience.
Complete your paperwork before your visit so your time with our care team stays focused on you, not the forms.
Before Your Visit
Preparing for Your Visit Is Easy.
At BluMine Health, we've simplified every step of your experience starting with your paperwork. Our secure digital forms let you complete everything in advance so your time during the visit is focused on meaningful care, not forms.
Secure
HIPAA-compliant
Mobile-Friendly
Phone & tablet
Quick
Done in minutes
Direct to Care
Sent to our team
Filling out forms on a phone or tablet? You'll need the free Adobe Acrobat Reader app installed first. Once downloaded, tap the form to open it inside Adobe Acrobat Reader.
New Patient Forms
Download & Complete Ahead of Time.
Click any form below to open the PDF. Fill it out digitally, save it, and bring it with you, or submit it ahead of your visit.
Form 01 · PDF
Patient Health History
Your medical background & current health information.
Form 02 · PDF
HIPAA Acknowledgement
Acknowledgement of receipt of privacy practices.
Form 03 · PDF
Informed Consent
Patient consent & authorization for care services.
Form 04 · PDF
Notice of Privacy Practices
How BluMine uses and protects your health information.
Need a Hand?
Questions About Your Forms?
We're happy to help. Reach out to our team and we'll walk you through anything you need.
