When you first visit the health center, our staff may ask you to fill out a number of forms.  These materials will help us to know how best to serve you and will give you a chance to let us know your health concerns.  You can download forms here to save yourself time at the health center.

There are two versions of the forms: electronic versions that allow you to complete the form on-screen and print out, and PDF that allows you to download, print out and complete by hand.  PDF documents require Adobe Acrobat Reader to open and print. This is a free program and is easy to install.  If you do not have Acrobat Reader, please install by using this link.

Printing, completing, and bringing forms with you such as your medical history and patient information, should help shorten your visit with us. The information you provide on all of these forms and your visit is strictly confidential (see HIPAA Privacy Statement).

If these forms are completed by hand, please make sure all forms are filled out in blue or black ink as we cannot accept forms filled out in pencil.  Please do not sign these forms until you come to the health center.

New Patients (nuevos pacientes)

If you are a new patient, you will need to complete these forms.  If you do not bring them with you, you will be asked to fill them out at the health center.
(Si es usted un nuevo paciente, por favor, llenar los siguientes formularios. Si no los trae con usted, se le pedira, que los llene en el Centro de Salud.)

Forms (Formularios)

Female Medical History	Historia médica para mujer
Electronic	Electrónico
PDF	PDF
Male Medical History	Historia médica para hombre
Electronic	Electrónico
PDF	PDF
Request for Medical Services	Solicitud de provisión de servicios médicos
Electronic	Electrónico
PDF	PDF
Patient Information	Información del paciente
Electronic (Tucson based Health Centers)	Electrónico (Centros de Salud en Tucson)
PDF (Tucson based Health Centers)	PDF (Centros de Salud en Tucson)
Electronic (All other Health Centers)	Electrónico  (El resto de los Centros de Salud)
PDF (All other Health Centers)	PDF (El resto de los Centros de Salud)

Other Ways to Prepare (Otras formas de prepararse)

Another way you can prepare for your visit is to make a list of your questions and concerns. Our staff members are happy to answer all of your sexual health questions, but we can't answer if you don't ask. Writing them down can help you remember everything you wanted to ask while you're at the health center.
(Otra forma que tiene usted para prepararse para su visita es hacer una lista de sus preguntas y preocupaciones. Nuestro personal amablemente estará dispuesto de responderle todas sus preguntas relacionadas con la salud sexual, pero no se podrá hacer, si usted no pregunta. Enumerarlas pueden ayudarle a usted a recordar todo, mientras esta en el Centro de Salud.)