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  • 802.770.1805
  • 802.773.4876
  • 8 Commons Street • Rutland, VT 05701
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    • Seth Coombs, MD
    • Bruce D. Bullock, MD
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  • Home
  • About
    • Seth Coombs, MD
    • Bruce D. Bullock, MD
    • Our Resources
      • Fletcher Allen Health Care
      • Dartmouth Hitchcock Medical Center
      • American Academy of Family Practitioners
      • American Academy of Private Physicians
      • Rutland Area Physical Activity Coalition
      • Health Insurance
        • Medicare
        • Medicaid
        • Insurance for Unemployed
      • Memory Care
        • Memory Care Facilities Vermont
        • Alzheimers Caregivers
        • Demantia Caregivers
    • Announcements
  • Services
    • Geriatric Medicine
  • Membership
  • Forms
  • Contact
  • Links
    • Video Visit FAQ’s & Setup Guide
    • Center for Disease Control and Prevention
    • VT Department of Health
    • VT Ethics Network
    • COLST Form
  • 802.770.1805
  • 802.773.4876
Login Portal
  • Home
  • About
    • Seth Coombs, MD
    • Bruce D. Bullock, MD
    • Our Resources
      • Fletcher Allen Health Care
      • Dartmouth Hitchcock Medical Center
      • American Academy of Family Practitioners
      • American Academy of Private Physicians
      • Rutland Area Physical Activity Coalition
      • Health Insurance
        • Medicare
        • Medicaid
        • Insurance for Unemployed
      • Memory Care
        • Memory Care Facilities Vermont
        • Alzheimers Caregivers
        • Demantia Caregivers
    • Announcements
  • Services
    • Geriatric Medicine
  • Membership
  • Forms
  • Contact
  • Links
    • Video Visit FAQ’s & Setup Guide
    • Center for Disease Control and Prevention
    • VT Department of Health
    • VT Ethics Network
    • COLST Form
  • Home
  • About
    • Seth Coombs, MD
    • Bruce D. Bullock, MD
    • Our Resources
      • Fletcher Allen Health Care
      • Dartmouth Hitchcock Medical Center
      • American Academy of Family Practitioners
      • American Academy of Private Physicians
      • Rutland Area Physical Activity Coalition
      • Health Insurance
        • Medicare
        • Medicaid
        • Insurance for Unemployed
      • Memory Care
        • Memory Care Facilities Vermont
        • Alzheimers Caregivers
        • Demantia Caregivers
    • Announcements
  • Services
    • Geriatric Medicine
  • Membership
  • Forms
  • Contact
  • Links
    • Video Visit FAQ’s & Setup Guide
    • Center for Disease Control and Prevention
    • VT Department of Health
    • VT Ethics Network
    • COLST Form

Forms

Below please find a list of forms you can download, print out and complete prior to coming into the office, as well as general notices and other information.
  • MVHW – Highlights and Details
  • Frequently Asked Questions
  • Patient Contact Information Form
  • Medical Information Release Form
  • Medical Records Request Authorization
  • Dartmouth Hitchcock – Patient Consent for Electronic Medical Record Access
  • Guidelines for Use of Electronic Communications
  • Join MVHW Patient Portal
  • Notice of Privacy Practices
  • Medicare Beneficiaries – Read This Before You Have Labs Drawn
  • COLST Form: https://vtethicsnetwork.org/2022-vt-dnr-colst-form
  • ADVANCE DIRECTIVE Form: https://www.healthvermont.gov/sites/default/files/documents/pdf/DNR_COLST_Instructions_Form.April%202020.pdf
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  • 802.770.1805
  • 802.773.4876
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  • 8 Commons Street Rutland, VT 05701
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