Forms & Downloads

NEW PATIENT FORMS

If you are a new CHC patient, click on one of the sets of available forms below to print.  Please fill out the forms as needed and bring them with you to your first visit.

• New Patient Registration Package - English
• New Patient Registration Package - Spanish
  
  
• New PEDIATRIC Patient Registration Package - English
• New PEDIATRIC Patient Registration Package - Spanish 
   
• Dental - New Patient Registration Package - English
• Dental - New Patient Registration Package - Spanish

• Dental - New PEDIATRIC Patient Registration Package - English
• Dental - New PEDIATRIC Patient Registration Package - Spanish

IMMUNIZATION FORMS

Please review this form for either adults or children receiving vaccinations.

• CAIR Disclosure Handout (English)
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• CAIR Disclosure Handout (Spanish)

SLIDING FEE PROGRAM

If you wish to participate in CHC's Sliding Fee Program, please print the form, fill out, and bring it with you for your visit.  Those who are already enrolled will need to renew their eligibility every 6 months.  See our payment section for more details.

• Sliding Fee Eligibility - English
• Sliding Fee Eligibility - Spanish 

MEDICAL RECORDS RELEASE FORMS

• Medical Records Release Authorization