For the convenience of our patients, the New Patient and Slide Fee Forms that you will need for your visit to our Primary Care and Dental Care centers are located below. Please print the forms and bring them with you completed to your visit with us. We look forward to serving your families Health and Dental Care Needs.
Apply for our sliding fee program. Our current slide fee program starts as low as $10 for a visit & includes most labs.
As a Federally Qualifying Health Center, we may be able to discount your deductible if you have Medicare and qualify for the sliding fee program.
Download Slide Fee Packet:
Make sure to download the additional forms for your service below.
Dental Patient Form:
(Don’t have insurance? Make sure to fill out the Sliding Fee Packet shown above too.)Dental New Patient Forms – English
Medical Patient Forms:
English:Adult New Patient Forms Pediatric New Patient Forms
¿No tiene seguro médico? Ofrecemos un programa gratuito de deslizamiento. No se requiere residencia.
Medical Release Forms
If you are moving to another practice or need a copy of your records for a specialty provider the forms for those are listed below:
Limited Medical Records Release Form (when you only want to release specific results- ie for a specialist)
Full Medical Records Release Form (when you want a full copy of your records)Learn about our partnership with Walgreens to save you on prescriptions!