Medical Forms

New Client Registration Forms

If you are a new patient planning to visit one of our health centers for an appointment, our Client Registration Form is available for you to print, complete, and bring to your appointment.

Client Registration Form - English

Client Registration Form - Spanish


Request for Medical Records

If you would like to request a copy of your medical records, please complete the form below and fax your request to the health center you visited most recently.  Fax numbers for each health center can be found on that center’s information page.

Request for Medical Records - English

Request for Medical Records - Spanish


Find A Health Center

or

Or Call
1-877-855-7526