For your convenience, some of our most common patient documents are available online. If you prefer to complete a hard copy, please contact us at 800-282-9905 and we’ll be happy to send what’s needed via U.S. mail.

Patient Information

Medical History

Authorization for Release of Patient Information (this form should be used if you would like St. Luke’s to be able communicate with someone about your healthcare or appointments.)

Authorization for Release of Protected Health Information (this form should be used if you are requesting your medical records for your own records or to be sent to another medical facility.)

Patient Statement of Rights and Responsibilities

Notification Regarding Patient Rights

Surgery Center Patient Information Card & Map

Lifestyle-Questionnaire

Hearing-Services-Questionnaire

Patient Information

Medical History

Authorization for Release of Patient Information (this form should be used if you would like St. Luke’s to be able communicate with someone about your healthcare or appointments.)

Authorization for Release of Protected Health Information (this form should be used if you are requesting your medical records for your own records or to be sent to another medical facility.)

Hearing-Services-Questionnaire

Patient Information

Medical History

Authorization for Release of Patient Information (this form should be used if you would like St. Luke’s to be able communicate with someone about your healthcare or appointments.)

Authorization for Release of Protected Health Information (this form should be used if you are requesting your medical records for your own records or to be sent to another medical facility.)

Refractive Evaluation Health History

Lifestyle-Questionnaire

Hearing Services New Patient Form

Hearing Services Questionnaire

Patient-Information-St.-Lukes-At-The-Villages

Medical History – St. Luke’s at The Villages

Authorization for Release of Patient Information – The Villages (this form should be used if you would like St. Luke’s to be able communicate with someone about your healthcare or appointments.)

Authorization for Release of Protected Health Information – The Villages (this form should be used if you are requesting your medical records for your own records or to be sent to another medical facility.)

Patient Statement of Rights and Responsibilities – St. Luke’s at The Villages

Notification Regarding Patient Rights – St. Luke’s at The Villages