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Home
Who We Are
Overview
Leadership
History
Care Providers
Locations
Services
All Women Count! Program
Community Health Program
Dental and Oral Health
Homeless HealthCare & Outreach Program
Immunizations
Iris Clinic
Medication Assistance Program
Medical
Mental Health
Outreach and Enrollment Program
Pharmacy
Sexual and Reproductive Health
Patient Resources
Employment
Release of Medical Information
Contact Us
Patient Forms
For Adult Registration
Adult Past Medical History Form
PDF Form
|
Online Form
Adult Discount Program Application
PDF Form
|
Online Form
Patient Consent For Treatment Form
PDF Form
|
Online Form
Patient Consent for Telehealth Treatment Form
PDF Form
|
Online Form
Self-Attestation Form Total Household Income
PDF Form
|
Online Form
For Minor Registration
Pediatric/Adolescent Health History Form
PDF Form
|
Online Form
Pediatric Discount Program Application
PDF Form
|
Online Form
Patient Consent For Treatment Form
PDF Form
|
Online Form
Patient Consent for Telehealth Treatment Form
PDF Form
|
Online Form
Self-Attestation Form Total Household Income
PDF Form
|
Online Form
Dental Registration
Dental Health History
PDF Form
|
Online Form
Discount Program Application
Adult Discount Program
PDF Form
|
Online Form
Pediatric Discount Program
PDF Form
|
Online Form
Patient Consent for Telehealth Treatment Form
PDF Form
|
Online Form
Self-Attestation Form Total Household Income
PDF Form
|
Online Form
Other info and forms
Patient Rights and Responsibilities Form
PDF
Notice of Privacy Practices
PDF
Patient Consent for Telehealth Treatment Form
PDF Form
|
Online Form