Patient Forms and Resources

The patient is at the center of all we do. That’s why we provide easier ways to access health services, in a compassionate and comfortable environment. We care about every person who walks through our door, respecting and responding to each health need.

Patient Forms:

• Informed Consent for Telehealth and Electronic Communication Services
• New Patient Intake Packet-English
• New Patient Intake Packet-Spanish
• Sliding Fee Program Enrollment Forms
  • Sliding Fee Scale Summary
  • Sliding Fee Scale Eligibility
  • Programa De Tarifas Deslizantes
  • Escala de Precios Reducidos
• SMS Terms of Service

Patient Resources:

• • Overview Brochure
  • Overview Brochure – Spanish
  • Patients Rights and Responsibilities
  • Patients Rights and Responsibilities – Spanish
  • Good Faith Estimate
  • Good Faith Estimate – Spanish
  • Notice to Patients
  • Notice of Privacy Practices (HIPAA)
  • Notice of Privacy Practices (HIPAA) – Spanish