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Forms for Your Visit

Please update your health history and demographic information.

Be sure to bring these completed forms to your appointment.

THANK YOU.

ENGLISH

Authorization for Treatment

Billing Consent Form

Patient Demographic Form

FLCH Release of Medical and Dental Information

Medication Consent Form

Consent to Receive Automated Messages

Sliding Fee Program Information

Sliding Fee Program Application

SPANISH

Authorization for Treatment

Billing Consent Form

Patient Demographic Form

FLCH Release of Medical and Dental Information

Medication Consent Form

Consent to Receive Automated Messages

Sliding Fee Program Information Spanish

Sliding Fee Program Application – Spanish

Patient Portal Quick Links.

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