New! Fill Out Your Forms Online!
Fill out your paperwork online in this easy 2 step process.
Step 1 – Visit our Portal Page for NEW PATIENTS using the button below. This initial step takes about 3 minutes.
You will be asked some preliminary info (personal contact info, emergency contact, etc.) If you have visited any of our medical or dental centers before, you do not need to complete the online request. Please call the center you would like to visit.
Step 2 – After you submit your intial info, our staff can send you a secure connection to complete the remainder of your new patient forms.
If you prefer good old paper and pen, the forms are shown below so that you can print them out.
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.
We accept slide fee forms from all of our patients – including those with insurance – as we like to offer sliding fee to any patient who qualifies.
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
Español:Formularios de pacientes nuevos para adultos Formularios de pacientes nuevos para pediátricos
¿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 new partnership with Walgreens to save you on prescriptions!