Patient Forms

Welcome to CHC! Below are many of the forms that you will encounter during your time as a patient with us. These forms allow us to treat you, receive or send your medical records, help you pay for care, and more. If you are interested in becoming a new patient, please fill out the first form in the list.

• New Patient Form: Click Here
  • Fill out this form completely and hit “submit,” and someone from our team will reach out over the phone to schedule your initial visit.
  • Please note that submitting this form does not automatically make you a patient of CHC.
• Release of Information
  • These formsallow your care teams to share your health information.
  • If you need CHC to send your health information to another practice, click here.
  • If you need another practice to send your health records to CHC, click here.
• Consent for Care of a Minor
  • If you are with a minor (patient under 18) who is receiving care from us, please fill out this form.
• Permission to Share Health Information
  • If you would like us to be able to share your health information with certain people you choose (such as close relatives) fill out the form above.
• Click here for Sliding Scale Fee Application
• School-Based Health Center Enrollment
• Mobile Dental Enrollment Forms
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