Doctor Terence Degan

Doctor Terence Degan, M.D.

El Dorado Hills Family Physician - General Practice, Primary Care, Pediatrics


Forms

The documents on this page are PDF files.  In order to open the link, you must have Adobe Reader installed on your computer.  If you need this program, you can download it for free at the Adobe web site.

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Forms for Download:
  1. Registration Record
  2. Health History
  3. Financial Policy
  4. Authorization to release medical records from your previous doctor
  5. Notice of Privacy Practices

Miscellaneous Forms:

  1. Advance Beneficiary Notice
  2. Authorization for Treatment of a Minor
  3. California Advanced Health Care Directive
  4. Durable Power of Attorney for Health Care

Note:  Documents requiring a signature must be printed and signed!

Instructions for Completing Forms:
These forms have fields that can be filled in by typing the information in on your computer.  The forms can be submitted in any of the following ways:
  • Open the document, print it, fill it out by hand, and mail or fax it to the office.
  • Open the document, fill it out on the computer, print it, and mail or fax it to the office.
  • Open the document, fill it out on the computer, save it on your hard drive, and email it to the office as an attachment.