Patient Resources

Patient Forms

We make our forms available online to facilitate and expedite your visit to our offices.

Please click on the links below or on the left for additional instructions on the form and how and when to return it.

Patient Registration

The Patient Registration process and subsequent form provides us with the information to set up your billing account with ARC. Information required includes demographics of each patient, responsible part for payment, and any health insurance information applicable to the patient. This form is required for all new patients to ARC, please refer to our Patient Registration Forms link for additional information.

Demographic

In collecting demographic information, ARC adheres to the standards that were established by the U.S. Office of Management and Budget (OMB) in 1997. It is the same standard used by the U.S. Census Bureau. The OMB requires five minimum categories for data on race:

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Native Hawaiian or Other Pacific Islander
  • White

The OMB requires two minimum categories for data on ethnicity: 

  • "Hispanic or Latino"
  • "Not Hispanic or Latino"

A patient's response to the race and ethnicity questions are based on self-identification and the patient may choose more than one race.

Orthopedic Patient Forms

Please print and complete the appropriate form below, and bring to your consultation for your doctor and nurse to review. It will provide the basic background orthopedic health information that will be a confidential part of your medical record.

MyChart® Registration & Caretaker Forms

MyChart® is ARC's easy-to-use patient portal that allows quick and easy access to you and your loved one's ARC health information anywhere and anytime. Visit the MyChart® Registration & Caretaker Forms page for more information on how you can sign up for MyChart® and how to also gain access to your child or loved one's medical information.

Patient Information and Consent for Treatment of a Minor

If you are the parent of a minor and would like your child to be seen by any of our providers without your presence, please fill out a Consent to Medical Treatment of a Minor form and have your child bring it to the appointment.

Release of Information (ROI) Forms

Whether you are a new patient requesting a transfer of your medical records to Austin Regional Clinic or an established patient requesting your medical records from ARC, a Release of Information Form is required. Please visit the Release of Information page for more information and to find the ROI form that best suits your needs. 



We Want To Hear From You

*By using this form to communicate with austin Regional clinic (ARC), the information will be transferred over the internet. ARC uses Transport Layer Security (TLS) encryption in order to secure the information you send to us over the internet. There may be times when we cannot respond to your request in email format and another method of communication will be used. For your privacy, please consider the information you include, and who, besides you, may have access to your email account.