Forms

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Patient Forms:

Adult Registration Form
Child Registration Form
Adult Medical Health History
Child Medical Health History
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

Patient Guide | Appointments | Walk-Ins | After Hour Emergencies
Payment for Services | Sliding Fee Scale | Private Health Insurance | Forms