Patient Forms
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Primary Care Registration
Primary Care Registration/Formulario De InscripciĆ³n Del Paciente
Sliding Fee Scale Application
Sliding Fee Scale Application
(Only Complete After Filing Patient Registration Form)Dental
Dental Treatment Consent & Health History
Patient Registration Form - Dental
Authorization to Release/Obtain Information
Behavioral Health
Mental Health Intake Form
Consumer Acknowledgments and Consent to Treatment
Client Notifications
Notificaciones al paciente acerca del tratamiento de salud conductual
School-Based Health
Consent Form
Age of Consent Info Letter
Edad de consentimiento mƩdico y de salud conductual
Student Needs Form English/Spanish
Pediatric Behavioral Health Intake Form
Pediatric Behavioral Health Intake ā 2nd Parent Informant
Pediatric Behavioral Health Intake ā Teacher Informant
Release/Disclosure of Information
Authorization to Release/Obtain Information
AutorizaciĆ³n Para Divulgar InformaciĆ³n
HIPAA Information – Notice of Privacy Policy
Notice of Privacy Practices - English and EspaƱol
Patient Concern
Patient Concern Form
Consent Forms
Vaccination Consent Form
Covid-19
Covid Testing Patient Registration Form