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Community Health Center of the Black Hills
  • 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
CHCBH Patient Forms CHCBH Patient Payment CHCBH Patient Portal
  • 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
  1. Patient Forms
  2. Self-Attestation Form Total Household Income
 
Community Health Center of the Black Hills
  • 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
CHCBH Patient Forms CHCBH Patient Payment CHCBH Patient Portal