Patient Information

We’re glad you are interested in becoming a patient at Aviva Health. Please take time to look at the documents below. They have important information about being a patient at Aviva Health.

For information or assistance applying for Insurance coverage, please visit our “Patient Resources” page.

Required Forms – Medical Services

Please complete forms thoroughly and bring them with you to your first appointment.

Adult and Pediatric Forms

These forms must be completed for all patients.

To share your medical records with Aviva Health providers, please fill out this form.

If you wish to share your Aviva Health medical records with outside providers, please fill out this form.

Sliding Scale Discounts

You may be eligible for discounts, even if you are insured. If you would like to apply for our sliding scale discounts, please complete the form below and submit with all requested documentation.

Spanish Documents