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Primary Care Registration

Primary Care Patient Registration (English)

Primary Care Patient Registration (Spanish)

Sliding Fee Discount Program Application

Only Complete After Filing Patient Registration Form

Sliding Fee Discount Program Application (English)

Sliding Fee Discount Program Application (Spanish)

Release/Disclosure of Information

Authorization to Release/Obtain Information (English)

Authorization to Release/Obtain Information (Spanish)

HIPAA Information – Notice of Privacy Policy

Notice of Privacy Practices (English)

Notice of Privacy Practices (Spanish)

Consent Forms

Vaccination Consent Form (English)

Vaccination Consent Form (Spanish)

Patient Concern

Patient Concern Form (English)

Patient Concern Form (Spanish)

Dental

Dental Treatment Consent & Health History (English)

Dental Patient Registration Form (English)

Authorization to Release/Obtain Information (English)

Dental Treatment Consent & Health History (Spanish)

Dental Patient Registration Form (Spanish)

Authorization to Release/Obtain Information (Spanish)

Behavioral Health

Mental Health Intake Form (English)

Consumer Acknowledgments and Consent to Treatment (English)

Client Notifications (English)

Mental Health Intake Form (Spanish)

Consumer Acknowledgements and Consent to Treatment (Spanish)

Client Notifications (Spanish)

School-Based Health

Consent Form (English)

Age of Consent Info Letter (English)

Student Needs Form (English)

Pediatric Behavioral Health Intake Form (English)

Pediatric Behavioral Health Intake – 2nd Parent Informant (English)

Pediatric Behavioral Health Intake — Teacher Informant (English)

Consent Form (Spanish)

Age of Consent Info Letter (Spanish)

Student Needs Form (Spanish)

Pediatric Behavioral Health Intake Form (Spanish)

Pediatric Behavioral Health Intake – 2nd Parent Informant (Spanish)

Pediatric Behavioral Health Intake — Teacher Informant (Spanish)

COVID-19

COVID Testing Patient Registration Form (English)

COVID Testing Patient Registration Form (Spanish)

Pediatric Questionnaires

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