Please fill out these forms to be submitted upon your arrival to the Rice Diet Center. You may type directly on these PDF forms (see note below). Please print the form after you have filled it out and bring a copy to the Rice Diet Center. Feel free to print an additional copy for your personal records.
Note: You may type on the first form (release of information form), but you will not be able to type in the fields requiring a signature. Please sign on the designated signature lines after you have printed the form.
The second form (authorization for medical information release form) does not require typing. Please print it up and fill out the form in pen.