Forms

Crystal Run provides online versions of commonly used forms for the convenience of our patients. Just fill out, print, and fax, mail, or bring the form you need for your next appointment.

Consent Forms:

Patient Caregiver Consent

Medical Release Forms:

Authorization for Crystal Run to Release Medical Information

Authorization for Crystal Run to Release Medical Information (Spanish)

Consent for Crystal Run to Release Pathology Slides/Block to Another Provider

Mammography Medical Release Authorization

Request for Medical Information to be sent to Crystal Run

Request for Patient Access to their PHI

Request for Patient Access to their PHI (Spanish)

Notice of Privacy Practices:

Notice of Crystal Run Privacy Practices

Registration Forms:

New Patient Registration Forms

Specimen Collection Instructions:

• Semen Sample Collection
• Sputum Sample Collection
• Stool Sample Collection
• Urine Sample Collection