New Patient Forms
New Patients Are Welcome
For the convenience of our patients, New Patient and Slide Fee Forms 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.
Slide Fee Packet
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.
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
Medical Patient Form:
English:
Medical PEDIATRIC - New Patient Forms
Medical ADULT - New Patient Forms
Medical AGED 65+ - New Patient Forms
Formulario de paciente médico:
En Espanol:
Formularios de Paciente Pediátrico
Formularios para Pacientes Adultos
Formularios para pacientes adultos de 65 años o más
¿No tiene seguro médico? Ofrecemos un programa gratuito de deslizamiento. No se requiere residencia.
Tarifa de deslizamiento - Espanol
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 here:
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)