Patient Forms


​IMPORTANT: For your convenience, please complete your new patient paperwork before your clinic visit. You may print the forms and complete them by hand or download the forms to your computer and complete them electronically. If you complete the forms electronically, you can print them and bring them to your clinic appointment. Alternatively, you can email them to patientservices@121.health, and we will print them for you and have them ready for your signature at your appointment. Please note that you must sign and date each form by hand.

Hep B Vaccine Documentation Form

TSSAA Sports Physical Form

How to Schedule an appointment:
  • Healow app- choose "Consultation" as appointment type, under "Notes" type in Sports Physical
  • Patient Portal- choose "Sports Exam" as appointment time 
  • Call support center (855) 571.4500- advise receptionist appointment is to be scheduled for a Sports Physical

Medical Information Release Form (HIPPA Release Form)