Follow these simple steps:
step1: click on the links for the forms
step2: print them out
step3: fill out the forms
step4: bring the completed forms to your visit.
Please note that Adobe Acrobat Reader is required to view the forms. You can download Acrobat reader for FREE by clicking here.
The information you provide on these forms is private and confidential. Answering the listed questions will help our staff provide you with the most appropriate and comprehensive health care. We ask that all patients fill out these forms before their first visit to the health center. Thank you for your cooperation.
Comprehensive Medical History Form / Español
Demographic Information Form (bilingual)
Forms needed for Durham health center patients:
Comprehensive Medical History Form/ Español
Forms needed for bc2me:
Email Permission Form
Form needed for record release requests:
Records Release Form