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Medical Forms

 Fill out forms in advance before your visit.

 DO

 DON'T

 Print single-sided  Print double-sided
 Fill out forms in blue or black ink  Use red or green ink (only blue and black please)
 Check or cross off boxes individually  Forget to bring your forms with you to your visit

FORMS FOR NEW PATIENTS

FORMS FOR RETURNING PATIENTS

You are a returning patient if you have been to this center within the past 2 years.

OTHER FORMS

Depending on the reason for your visit, you may have other forms to complete.  If you have questions, call your Health Center.

 


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1-800-230-PLAN