On occasion, you may be asked to complete and return a form to Westgrove Clinic.  Below are some of those forms that we regularly use in the office.

Description of forms: 

  • Consent to Disclose Health information - Use this form when you are authorizing another person or entity to have access to your health information (i/e family member or insurance company)
  • Email Communication Consent Form - Use this form to authorize the use of electronic communication with your doctor and clinic support staff
  • Request for Personal Health Records - Use this form to request a copy of your own health records.   
    Please note: if you are requesting a large amount of information there is a $25 fee for the preparation of your heath records. 

Westgrove Clinic Forms



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