Forms

There is a $10 fee for form completion when the request is not associated with an appointment. Also, the patient must have been seen by an Apple Ridge doctor/nurse practitioner within the past 6 months. All FMLA forms must be accompanied by an appointment and are not covered by the form fee.

 

New Patient

Please use our secure online form to complete your new patient paperwork, prior to your appointment. Failure to complete the form will result in the rescheduling of your appointment. If you have any questions completing the online form, please give us a call at (717) 334-8165.

DOT Physical Package

                                   our DOT Physical Package paperwork. Currently we are only offering the DOT Physical Package for current family practice patients. If you have any questions about completing the forms, please give us a call at (717) 334-8165

DOT Drivers that are Insulin Dependent

For DOT drivers that are insulin-dependent, please download our DOT Insulin Treated Diabetes Assessment Form. If you have any questions about completing the forms, please give us a call at (717) 334-8165

Medical Marijuana

Please use our secure online form to complete the paperwork for the program. After we receive your online form submission, our staff will be in contact to schedule an appointment. Please note, if an online form submission is not received, you will be asked to reschedule until it has been completed.

To learn more about registering with the state prior to the appointment, click here.

Opioid/Alcohol Abuse Treatment

We have two programs at Apple Ridge Family Medicine to help with recovery from opioid or alcohol dependency. Please complete our secure online form to get started. After we receive your online form submission, our staff will be in contact to schedule an appointment.

Suboxone Program 

Do you or a loved one struggle with addiction? We can help.