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    Medical Forms

    If you are already are a patient in Bloomer or have made your first appointment, use these forms to request your medical records, release health care information, complete a medical history and more.

    General Forms:

    • Power of Attorney – Delegated Parental Power

    History Forms:

    • Primary Care History Form
    • Neurology History Form

    Medical Record Forms:

    • Authorization to Release Health and/or Behavioral Health Care Information
    • Request to Amend Your Medical Record
    • Request Your Medical Record

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