1215 Southtown Boulevard, Suite 303, Owensboro, KY 42301

TEXT or Call: (270) 570-9535

TEXT or Call: (270) 570-9535

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  • About Us
  • New Patients
  • Forms
  • Pay Here
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  • More
    • Home
    • About Us
    • New Patients
    • Forms
    • Pay Here
    • FAQs
    • Request An Appointment
  • Home
  • About Us
  • New Patients
  • Forms
  • Pay Here
  • FAQs
  • Request An Appointment

Forms for New Patients

New Patient Forms

To help reduce anxiety during your visit to our medical cannabis clinic, please PRINT and complete our new patient forms before your appointment. Providing your medical history in advance allows our physician to focus entirely on your treatment plan.

Patient Financial Responsibility Form (pdf)

Download

Consent for Treatment (pdf)

Download

New Patient Demographics & Medical History (pdf)

Download

Notice of Privacy Practices (pdf)

Download

Acknowledgment of Receipt of Notice of Privacy Practices (pdf)

Download

Telehealth Consent (pdf)

Download
  • Home
  • About Us
  • Forms
  • Pay Here
  • FAQs
  • Request An Appointment

Affinity Botanical Medicine

1215 Southtown Boulevard, Suite 303, Owensboro, KY, USA

270-570-9535

Copyright © 2026 Affinity Botanical Medicine - All Rights Reserved.

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