New Patient Registration Forms

New patients should complete the following forms in their entirety:

New Patient Registration Forms (Children under 18)

Family Assistance Plan - information

Family Assistance Plan - application

Patient Registration

Patient Health Questionnaire

Medical Records Release

Patients under the age of 18 should have the following forms completed in their entirety by a parent or guardian:

Patient Registration

Pediatric Patient Health Questionnaire

Medical Records Release

Family Assistance Plan (for uninsured patients)

Family Health Center Notice of Privacy Practices