REGISTRATION DOCUMENTS

Included in the Registration Download: 

• Registration Form – This form must be filled out once initially by all patients.
Click to Download:  English – Espanol

• Consent to Treatment Form – This form must be signed annually.
Click to Download: English – Espanol

• Sliding Fee Scale – This form is required for signing up for our sliding fee scale.
Click to Download: English – Espanol

• Authorization for Proxy Access – This form is required to be completed by all minors.
Click to Download:  English – Espanol

• Legal Guardian Form – This form is required to be completed by all minors.
Click to Download: English – Espanol

• Patient Authorization for Personal Representative – This form is required when a minor will be accompanied by someone other than their legal guardian.
Click to Download:  English – Espanol

• Authorization for Release of Medical and Dental Records – This form is for new patients transferring from another clinic. This is required to give access to medical records from the prior health center.
Click to Download: English – Espanol

• Notice of Privacy Practices – This form is just for information purposes and requires no signatures.
Click to Download: English – Espanol