New Patient Forms
New Patients Are Welcome
For the convenience of our patients, New Patient and Slide Fee Forms are located below.
Please print the forms and bring them with you completed to your visit with us.
We look forward to serving your families health and dental care needs.
Scroll Down - to view/download the additional
Desplácese hacia abajo para español
Slide Fee Packet
Apply for our sliding fee program. Our current slide fee program starts as low as $25 for a visit & includes most labs.
As a Federally Qualifying Health Center, we may be able to discount your deductible if you have Medicare and qualify for the sliding fee program.
Slide Fee Forms - English
Tarifa de deslizamiento
Dental Patient Form
(Don’t have insurance? Make sure to fill out the Sliding Fee Packet shown above too.)
Dental New Patient Forms
Paquete de Registro para Pacientes Dentales
Medical Patient Form
English:
Medical PEDIATRIC - New Patient Forms
Medical ADULT - New Patient Forms
Medical AGED 65+ - New Patient Forms
Formulario de paciente médico
En Espanol:
Formularios de Paciente Pediátrico
Formularios para Pacientes Adultos
Formularios para pacientes adultos de 65 años o más
Medical Release Forms
If you are moving to another practice or need a copy of your records for a specialty provider, the forms for those are listed here:
Limited Medical Records Release Form
(when you only want to release specific results- ie for a specialist)
Full Medical Records Release Form
(when you want a full copy of your records)