FORMS


Description English Spanish
Patient Demographics (Print, complete, and bring forms to first visit.) Download Descargar
Sliding Fee Application (Print, complete, and bring forms to first visit.) Download Descargar
Welcome Book (Patient Information) Download Descargar
Medical Release Form Download

​This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. For more information, see http://www.bphc.hrsa.gov/ftca/. ​