Patient Forms

Filling out healthcare forms before a scheduled hospital stay is more convenient for patients. Patients can bring their completed forms with them when they register.

Patient Forms Available

• Blessing Health System Consent to Treat and Authorizations

• Health Information Exchange Patient Opt-Out Form

• Consent for Treatment of Minors

• Medication Record: A simple form to keep track of the medicines you take on a regular basis.

• Advanced Directives

• Minor Patient Health Portal Agreement and Consent Form
• Minor Patient Health Portal Agreement and Consent Form (online form)

Looking for Your Birth Certificate?

If you were born at Blessing Hospital or St. Mary Hospital and need a copy of your birth certificate, please call the Adams County Department of Vital Statistics at (217) 277-2158 or print a request form from their website.