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Medical Forms

For your convenience, UCI Medical Center is in the process of placing some of the patient forms online. Due to patient confidentiality,  we can not accept the forms via e-mail. We are placing forms online in an Adobe Acrobat format so that you can print them and fill them out at home. 

Patient Health Survey (Medical history)

Patient Nutritional Health Form (PDF)

Authorization for Release of Information from Medical Record and FAQ's 

Advance Directives