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.
School-Based Health Clinic (SBHC) Forms
NOTICE: There are separate forms for students & school faculty/staff.
Forms for other schools will be available soon.
Sliding Fee Discount Program
(Patient Financial Assistance)
When approved, you will receive a percentage discount* on services.
To apply, fill out these forms and return them to the clinic to apply.
* Discount is based on family size and income. Proof of income is required. If you have $0 income, there is a Support Form included in the application packet to be filled out by the person who pays your bills and expenses.