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MyChart - Patient Portal



- para espanol, presione aquí

For your convenience, Facey has made our patient registration forms available online. After filling out the appropriate forms, please bring them with you to your first appointment, along with your insurance card and a photo ID.   Please be aware that, at this time, these forms can not be submitted to Facey electronically.    Adobe Reader® will be needed to open the forms, and can be obtained here.

*All patients must read and/or sign the Privacy documents noted by the asterisks * below.

Adults (Ages 18 & up)
Pediatrics (Ages 0-17)
Patient Information Sheet
Pediatric Medical History
Temp. Auth for Consent to Treat a Minor
Information Regarding 3rd-party
Obstetrics & Gynocology (OB/GYN)
First Visit to the OB Office
Genetic Screening Information Sheet
Advance Directives
  • English 788 KB
  • Spanish 900 KB
  • Spanish-English 3.7 MB
  • Chinese-English 4 MB
  • Korean-English 3.7 MB
  • Tagalog-English 3.7 MB
  • Privacy & Information Release
    Welcome from Health Information Mgmt
    Notice of Privacy Practices *
    Acknowledgement of Notice of Privacy Practices *
    Amendment Request Form
    Restriction Request Form
    Authorization to Release Medical Info
    Internet Privacy Policy

    The Proxy form needs to be turned in directly to the Doctor's office in person. Adults can register in person at the time of their next Doctor's appointment.

  • MyChart - Proxy Access Form
  • MyChart - Proxy Access Form - Spanish
    Additional Resources
    Prescription Refills FAQ

    New Patient Welcome Packet

    Primary Care Providers 1.3 MB

    Facey Phonebook 2.3 MB