Patient Portal Access

New Patient
Thank you for choosing Jefferson Internal Medicine for your health care needs. 

For your convenience we have our new patient forms available to download.  Once you have completed the forms, they can be uploaded to us via the PATIENT PORTAL or faxed directly to us at (412) 469-7766.  If you are not able to send us the completed forms electronically, then please bring them with you to your appointment.



New Patient Health HistoryHealth History Form for New Patients to bring completed to their first appointment.
Medical Records Release TO our officeForm used to have your medical records from other doctors sent to Jefferson Internal Medicine
Notice of Privacy PracticesThis notice describes how medical information about you may be used or disclosed.

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