• 7008 Indiana Ave Suite A, Lubbock, TX
  • (806) 698-8088
  • info@lubbockfamilymedicine.com
New Patient Information HIPPA Privacy Policy Medical Records Release
Are you a new patient or do you have a child
or dependent that will be a new patient? You
can save the time required to fill out the new
patient information by downloading this form so you can print it out and complete it on your own schedule. Just bring it with you at your next visit. New Patient Information
This Notice describes how your medical information may
be used or under what circumstance it may be disclosed.
Please review this information carefully. If you have any questions about this notice, please contact Gus Khan or Justin Cogburn at 806-698-8088 HIPPA Privacy Policy
Download and complete this form to authorize Lubbock Family Medicine to release your medical records. Return the completed form at your next visit. Medical Records Release