Forms

Click on a form below to download and print using the free Adobe Acrobat Reader.

Patient Forms:

Adult Registration Form
Child Registration Form
PHQ Screening Form
Contact Consent Form
Farmworker Status Information
HIPAA Notice to Patients
Patient Rights and Responsibilities

Silding Fee Program Forms

Required Documents for SFS Program
Sliding Fee Scale Program Application


 







Chiricahua Community Health Centers, Inc. 
| Douglas Administration/Business Office 520.364.1429 | Elfrida 520.642.2222 | Bisbee 520.432.3309 | Douglas 520.364.3285 | 
Sierra Vista/MMC 520.459.3011| PCE 520.364.KIDS (5437)