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New Patient Forms

Forms in English

Nashville CARES Clinic at My House provides comprehensive health care including STI testing, PrEP, HIV medical care and Primary Care for established patients. To become a patient at the Nashville CARES Clinic at My House please call the clinic at 615-499-7406 to schedule your first appointment.

Consent for Treatment

HIPAA Release of Information

Medical Records Release Form

Receipt of Privacy Practices Summary

Summary Notice of Privacy Practices

Formas En Español

Complete los formularios, imprímalos y tráigalos a su primera cita.

Consentimiento para Tratamiento

Divulgación de información HIPAA

Formulario de divulgación de registros médicos

Recibo del resumen de prácticas de privacidad

Aviso resumido de prácticas de privacidad