If you wish, download and print these forms and complete them in advance. Bring them with you to your appointment and turn them in at the front desk. If you have any questions about these forms, the staff at the front desk can help you. If you receive a link to complete these forms in CHADIS, you will not be required to print out the forms and bring them to the clinic.
New Patient Paperwork
- New Patient Packet including Registration and Consent Forms (English | Spanish)
- Appointment Policy (English | Spanish)
- Notice of Patient Rights and Responsibilities (English | Spanish)
New Behavioral Health Patient Forms
Financial Screening / Program Registration Interview
- What To Bring To Your Program Registration Interview (List of Acceptable Documents)
- Statement of Self Employment Income (English | Spanish)
- Income Verification Form for Non-employed Patients (English | Spanish)
Medical Records Request Forms
Healthmark Authorization Form and Letter (English | Spanish)
