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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

Patient Demographic Form

Patient Household and Income Information Form

Authorization for Release of Medical and Dental Information

Medication Consent Form

Consent to Receive Automated Messages

Sliding Fee Program Information

SPANISH

Authorization for Treatment

Patient Demographic Form

Patient Household and Income Information Form

Authorization for Release of Medical and Dental Information

Medication Consent Form

Consent to Receive Automated Messages

Sliding Fee Program Information

Patient Portal Quick Links.

Call the health center nearest you for an appointment today!