Patient Forms
When you are ready to schedule your appointment, we encourage you to print and complete the following forms to save you time. You will need Adobe Acrobat to download these forms.
All of these forms are available at the health care center, as well.
Forms for NEW Patients
New Patient Registration Form (PDF)
Female Health History Form (PDF)
Male Health History Form (PDF)
*Request for Medical Services - English Form (PDF)
*Request for Medical Services - Spanish Form (PDF)
Forms for RETURNING Patients
Female Annual Exam (PDF)
*Request for Medical Services - English (PDF)
*Request for Medical Services - Spanish (PDF)
Forms for STD/HIV Testing appointments
Female Health History Form (PDF)
Male Health History Form (PDF)
STD Assessment (PDF)
HIV and other Blood Testing (PDF)
*Request for Medical Services - English (PDF)
*Request for Medical Services - Spanish Form (PDF)
*We are required by law to collect this form before providing any medical service.
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