Sierra Rheumatology
Patient forms

Complete what you need — securely and online.

Filling out forms online means we spend more of your appointment focused on your care. Each form below opens in a guided, mobile-friendly page. If you can't find what you need, give us a call.

New patients

Patient intake & records.

Start here if it's your first visit, or if your information has changed.

New patient intake
New Patient Intake — Patient History Form

Comprehensive patient history — biographical information, symptoms, systems review, medical history, family history, medications, ADLs and HIPAA / financial acknowledgements.

~25 min↓ blank PDF
Disease activity

Self-assessment questionnaires.

Brief, validated tools we use to track how you're doing visit-to-visit.

Disease activity
RAPID 3 — Routine Assessment of Patient Index Data

A 13-item self-assessment used to track rheumatic disease activity over time.

~5 min↓ blank PDF
Disease activity
BASDAI — Bath Ankylosing Spondylitis Disease Activity Index

Six self-rated questions about fatigue, pain, and stiffness over the past week.

~3 min↓ blank PDF
Symptom screening
ANA (+) Screening for Systemic Lupus Erythematous

Symptom screen used when a patient has a positive ANA blood test result.

~4 min↓ blank PDF
Releases & authorizations

Records release & HIPAA forms.

Authorize us to share information with family, providers, or others involved in your care.

Records release
Patient Authorization Form — Authorization to Release Information

HIPAA authorization for us to discuss your care with family or other providers.

Open form↓ blank PDF
Medication consents

Informed consent for biologic therapies.

Please review and sign the consent form for your medication before infusion.

Medication consent
Informed Consent for Treatment with Actemra (tocilizumab)
Open form↓ blank PDF
Medication consent
Informed Consent for Treatment with Benlysta (belimumab)
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Medication consent
Informed Consent for Treatment with Cimzia (certolizumab pegol)
Open form↓ blank PDF
Medication consent
Informed Consent for Treatment with Cosentyx (secukinumab)
Open form↓ blank PDF
Medication consent
Informed Consent for Treatment with Krystexxa (pegloticase)
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Medication consent
Informed Consent for Treatment with Orencia (abatacept)
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Medication consent
Informed Consent for Treatment with Prolia (denosumab)
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Medication consent
Informed Consent for Treatment with Reclast / Zoledronic Acid
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Medication consent
Informed Consent for Treatment with Remicade / Inflectra (infliximab)
Open form↓ blank PDF
Medication consent
Informed Consent for Treatment with Rituximab (Rituxan / Truxima / Ruxience)
Open form↓ blank PDF
Medication consent
Informed Consent for Treatment with Saphnelo (anifrolumab-fnia)
Open form↓ blank PDF
Medication consent
Informed Consent for Treatment with Simponi Aria (golimumab)
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Need help?
We're happy to walk you through any document over the phone.