Documents and Privacy Practices

Important Information

MyChaseBrexton.org - Your Patient Portal! Communicate with your Chase Brexton provider, make a fast, secure bill payment, request a prescription refill, view your lab results, and much more. 

Notice of Privacy Practices

Patient Bill of Rights

Before your first appointment, you will need fill out the New Patient Packet for the service you are receiving. If you have access to a printer, please print and bring these forms to your first appointment.

New Patient Packets

Adult Medical, Behavioral Health, Social Work, OB/GYN

Dental 

Pediatrics

 

Other Important Information

Verification of No Income

Sliding Fee Scale FAQ

Allow Chase Brexton to Discuss Your Care: 

 

Request Records from an Outside Provider   

Request Records from Chase Brexton 

Designation for Another Person to Consent for Medical Care Form

New Patient Packets

Adult Medical,  Behavioral health, social work, OB/GYN 

Dental

Pediatrics

Other Important Information

MyChaseBrexton.org - Your Patient Portal! Communicate with your Chase Brexton provider, make a fast, secure bill payment, request a prescription refill, view your lab results, and much more. 

Notice of Privacy Practices

Patient Bill of Rights

Verification of No Income:  English // Spanish

Sliding Fee Scale FAQ: English // Spanish

Allow Chase Brexton to Discuss Your Care: English  //  Spanish

Request Records from an Outside Provider:   English  //  Spanish

Request Records from Chase Brexton: English  //  Spanish

Designation for Another Person to Consent for Medical Care Form: English // Spanish

Your Health History - A Short Record for Your Own Knowledge