Online Forms

Speed up your visit with our online forms! Simply download each form, fill them all out and send the completed forms to Once we have received your forms we will reach out to you via phone to schedule your appointment. This will help us create more paper-free visit during these COVID-19 times.

To confirm insurance coverage, please call our office ahead of time at 401-921-5855.

All Forms

Download all forms

Click Here to download and print all of the forms necessary for your first appointment.

Individual Forms

Patient Info Sheet

This form provides primary information including insurance details, HIPAA authorization, and consent for billing. Click Here.

Policy and Procedures

Patients must be responsible for their financial oblications and keep their given appointments. Click Here.

Pain Management and Our Office

A to Z Primary Care is not a pain management clinic and they do not prescribe narcotic drug therapies for chronic pain management. Click Here.

List of Specialists

A listing of your current specialists, if any. Click Here.

Medical History

A current disclosure of medical information including medications and brief past medical history. Click Here.

Family History

A best-knowledge disclosure of family medical conditions, history, and health maintenence. Click Here.

Medical Release

Authorization of release of confidential information to/from A to Z Primary Care. Click Here.