What forms do I need as a new patient?

New patients should complete the New Patient Registration form, Medical History Form, Current Medications List, and HIPAA Privacy Notice. Mental health patients also need the Mental Health Intake Form.

What insurance plans does Roth Family Medicine accept?

We accept most major insurance plans including Blue Cross Blue Shield of Idaho, Regence BlueShield, PacificSource, SelectHealth, Aetna, Cigna, United Healthcare, Medicare, Medicaid, and more. Call to verify your specific plan.

How do I request my medical records?

Complete a Release of Medical Records authorization form available at our office or by calling us at 208-904-4705. Allow 5–7 business days for processing.

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Roth Family Medicine

Patient Resources

Everything you need to prepare for your visit — forms, insurance information, and answers to common questions.

Patient Forms Insurance FAQs Contact Us

Patient Forms

To save time at your appointment, please complete the appropriate forms before your visit. Forms are available at our office if you prefer to complete them in person — just arrive 15 minutes early.

New Patient Registration

Complete before your first visit to save time at check-in. Includes demographic information, emergency contacts, and consent to treat.

Please arrive 15 minutes early if completing in office.

Medical History Form

Comprehensive health history including past diagnoses, surgeries, hospitalizations, family history, and current symptoms.

Required for all new patients.

Current Medications List

List all prescription medications, over-the-counter drugs, vitamins, and supplements with dosages.

Bring original bottles or a printed list to your appointment.

Mental Health Intake Form

For patients scheduling mental health, ketamine, or TMS consultations. Includes PHQ-9, GAD-7, and treatment history.

Required for all mental health and specialty appointments.

HIPAA Privacy Notice & Acknowledgment

Our Notice of Privacy Practices explains how we use and protect your health information.

Required signature at first visit.

Release of Medical Records

Authorize us to send or receive records from other providers, hospitals, or specialists.

Allow 5–7 business days for processing.

Completing Forms at the Office

All forms are available at our front desk. Please arrive 15 minutes before your scheduled appointment if you plan to complete paperwork in office. Our staff is happy to assist you.

More Resources

Insurance & FAQs

Insurance We Accept

We accept most major plans including Blue Cross, Regence, PacificSource, Medicare, Medicaid, and more. View the full list and coverage notes by service.

Blue Cross Blue Shield of IdahoRegence BlueShieldPacificSource Health PlansSelectHealth+8 more

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