Patient Agreement Form

This form details the agreement between Sovereign DPC/Dr. Youga and the patient, outlining the expectations for both parties.

Notice of Privacy Policies

This form contains Sovereign DPC's policies and practices regarding protected health information and how we keep it safe along with your rights as a patient of Sovereign DPC. This form does not need need to be signed but the acknowledgement form below does.

Notice of Privacy Policies - Acknowledgement Form

This form is required to let Sovereign DPC know that you have read and understand your rights in regards to how Sovereign DPC uses and protects your protected health information.

Photo ID & Insurance Care Copy Consent Form

This consent form gives Sovereign DPC permission to copy your photo ID and insurance card and to keep that copy within your patient chart. This is necessary for the practice to be able to work with your insurance company and other systems on your behalf.

Telehealth Agreement Form

This form details the essential requirements for conducting telehealth visits. Telehealth visits cannot take place without the completion of this form.