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Patient Forms & Consents

Patient forms and consents are an important part of the health care process. By completing these forms and providing consent, you can help ensure that your health care team has all the necessary information to provide you with the best possible care.

Sliding fee scale Discount
OUR

Patient Forms & Consents

Patient forms and consents are an important part of the health care process. By completing these forms and providing consent, you can help ensure that your health care team has all the necessary information to provide you with the best possible care.

Sliding fee scale Discount
OUR

Patient Forms & Consents

Patient forms and consents are an important part of the health care process. By completing these forms and providing consent, you can help ensure that your health care team has all the necessary information to provide you with the best possible care.

For Sliding Fee Scale Patients

Required documentation includes income verification for the household (last year’s income tax, check stub, letter from employer, unemployment, etc.)
Sliding fee scale discount application
Sliding fee scale Discount Application - Spanish
Sliding fee scale Discount Information

For Sliding Fee Scale Patients

Required documentation includes income verification for the household (last year’s income tax, check stub, letter from employer, unemployment, etc.)
Sliding fee scale discount application
Sliding fee scale Discount Application - Spanish
Sliding Fee Scale Discount Information

For Sliding Fee Scale Patients

Required documentation includes income verification for the household (last year’s income tax, check stub, letter from employer, unemployment, etc.)
Sliding fee scale discount application
Sliding fee scale Discount Application - Spanish
Sliding fee Discount Information

The Following Forms can be Printed and Completed in Advance for Appointments

The Following Forms can be Printed and Completed in Advance for Appointments

Please bring the following information to each appointment: Demographic Forms (New Patient/Annually), Current Medications, Current Insurance, Medicare Card, Medicaid Card, Picture I.D., etc.

Patient Demographic Forms (English)

Click the button below to access our Medical Patient Forms.
Click Here

Formulario Demográfico del Paciente

Accede a nuestros formularios médicos haciendo clic abajo.
Haz clic aquí.

Behavioral Health Consent Form (English)

Click the button to below to access our BH Consent Form.
Click Here

Formulario de Consentimiento de Salud Conductual

Accede a nuestros formularios médicos haciendo clic abajo.
Haz clic aquí.

Dental Consent Form For Patients (English)

Click the button below to access our Dental Consent Form.
Click Here

Formulario de Consentimiento Dental.

Haz clic abajo para acceder al formulario de consentimiento dental.
Haz clic aquí.

Patient Satisfaction Survey (English)

Click the button to below to access our Patient Satisfaction Survey.
Click Here

Encuesta de Satisfacción del Paciente.

Haz clic abajo para la encuesta de satisfacción del paciente.
Haz clic aquí.
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