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Patient Forms for downloading

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        Permission for Medical Treatment

        Consent to Medical Treatment

        School Physical Form

        Immunization Form

        Authorization for Use or Disclosure of Protected Health Information Form

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        • Home
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        • Contact Us
        • Price Transparency Page
        © 2025 Thayer County Health Services
        • Home
        • About Us
          • About Us
            • TCHS Leadership
            • TCHS Strategic Plan
            • Mission Statement
            • TCHS History
            • Our Locations
            • Our Community
          • Foundation & Guild
            • Foundation
            • Thayer County Health Services Guild
          • News
            • Board Minutes
            • Board Agenda
        • Services
          • General Services
            • Satellite Clinic Information and Schedules
            • Acute Care
            • Ambulance Services
            • Labor & Delivery, OB/Family Services
            • Swing Bed Program
            • Patient & Family Services
            • Advance Directive
            • Pharmacy Services
            • Behavioral Health
            • Senior Life Solutions
          • Medicare Services
          • Outpatient Services
            • Sleep Studies
            • Cardiopulmonary Services
            • Emergency Services
            • Foot Care
            • Educational Services
            • Childbirth Education
            • Car Seat Safety Education
            • Diabetes Education
            • Wellness Services
          • Rural Health Clinics
          • Specialty Clinic
            • Cardiology
            • Chronic Pain Management
            • Ear, Nose and Throat
            • General Surgery
            • Neurosurgeon
            • Oncology & Hematology
            • Orthopaedics
            • Podiatry
            • Urology
            • Vascular Surgery
            • Women’s Health & OB/GYN
            • Wound Clinic
          • Diagnostic Services
            • Laboratory Services
            • Radiology Services
            • Rehabilitation Services
          • Outpatient/Inpatient Surgery
            • General Surgery
            • Ear, Nose & Throat (Otolaryngology)
            • Ophthalmology
            • Orthopaedics
            • Oncology & Hematology
            • Podiatry
            • Urology
        • Patients and Visitors
          • Suggestion Form
          • Patient Info
            • Patient Portal
            • Online Medical Records Request
            • Immunizations
            • Visitor Info
            • Patient Forms
            • Diabetes Education
            • Notice of Privacy Policy
            • Patient Family Advisory Council
          • Billing / Payment Info
            • Pay Your Bill
            • Price Transparency
            • The No Surprises Act
            • Financial Assistance
          • Patient Testimonials
        • Little Blue Bistro Menu
        • Providers
          • Our Physicians & Medical Staff
        • Wellness
          • Corporate Wellness
          • Korff Fitness & Wellness Center
          • Freedom Fun Run
          • Smart Moves Program
          • Glenn Korff
        • Careers
          • Employee Testimonials
          • Career Opportunities
          • Job Shadow Program
          • Healthcare Scholarship
        • Contact Us
        • Price Transparency Page