Medical Clinic Patients

Please fill out these forms and bring with you to your first visit to expedite the registration process.


Dental Clinic Patients

Please fill out these forms and bring with you to your first visit at our dental clinic to expedite your registration.


Sliding Fee Discount Program
(Patient Financial Assistance)

When approved for our Sliding Fee Discount Program, you receive a percentage discount on services, which is based on your family size and income.* Fill out these forms and return them to the clinic to apply.

* Proof of income is required. If you have $0 income, there is a Support Form (in the application packet) to be filled out by the person who pays your bills and expenses.