Request
Choose a service and preferred date.
Patient Resources
Your care. Your way.
Prepare for your visit, complete forms, and find the tools you need to take an active role in your healthcare.
New Patients
Prepare for your first appointment.
Bringing complete information helps us get to know you and make the most of your visit.
Government-issued photo ID
Insurance card, if applicable
Current medications, vitamins, and supplements with dosage
Medication allergies and known reactions
Relevant medical history, surgeries, and hospitalizations
Recent laboratory or imaging results, if available
Preferred pharmacy name, address, and phone number
Emergency contact and previous provider information, if applicable
Confirm
Our team will contact you to confirm.
Complete
Finish your forms before the visit.
Visit
Arrive prepared to begin your care.
Patient Forms
Complete your documents ahead of time.
Forms are organized by registration, privacy, and service-specific needs. Each form’s availability is managed from the CMS.
Registration & Care
New Patient Registration
Personal details, contact information, insurance, and care preferences.
Medical History
Medical conditions, surgeries, hospitalizations, medications, and allergies.
Consent for Treatment
General consent to receive medical evaluation and care.
Financial Policy
Payment responsibilities, insurance, balances, and financial arrangements.
Cancellation & No-Show Policy
Expectations for cancelling or rescheduling an appointment.
Patient Rights & Responsibilities
Information about participation, respect, privacy, and responsibilities.
Privacy & Permissions
HIPAA Notice Acknowledgment
Acknowledges receipt of the Notice of Privacy Practices.
Authorization to Release Medical Records
Provides written authorization to send medical information to a named person or organization.
Service-Specific
Telehealth Consent
Information and consent for receiving care through a virtual visit.
Insurance & Self-Pay
Flexible options for your healthcare.
Our team can help you understand the available options. Verification of benefits does not guarantee payment by your insurance carrier.
Using Insurance
- Bring your current insurance card
- Confirm copays, deductibles, and coinsurance
- Ask whether a referral or prior authorization is required
Available now
Patient Portal
Your health information in one place.
Access a private space where you can manage your care securely and conveniently.
Patient Portal — Coming Soon
View and manage appointments
Access available medical information
Review laboratory results
Complete forms
Send secure messages
Request prescription refills
Access visit information
Request medical records
Do not use the portal for emergencies. If you have a medical emergency, call 911.
Prescription Refills
Request your refill before you run out.
Contact Harmony Community Clinic or, when available, submit your request through the Patient Portal.
- 1Identify the medication, dosage, and frequency
- 2Confirm your preferred pharmacy
- 3Submit the request for clinical review
- 4Check the status through the portal or clinic
Medical Records
Request access or authorize the release of your records.
Patients may request access to available information or provide written authorization for records to be sent to another person or provider.
- Select the records and dates you need
- Tell us where they should be sent
- Complete and sign the appropriate authorization
- Our team will review the request and contact you
Request an Appointment
Begin your care with Harmony.
Choose a service and preferred date. Our team will contact you to confirm availability.
Your information is used only to respond to your request.
Online appointment requests are coming soon.
For now, please call the clinic to request an appointment.