Forms Health & Finance

Medical

• Non-Parental Consent for Minors ENGLISH
• Non-Parental Consent for Minors SPANISH
• New Patient Form ENGLISH/SPANISH
• Annual Wellness Visit Form Form ENGLISH/SPANISH

Dental

• Oral Health History Form ENGLISH
• Oral Health History Form SPANISH

School Based

• School Based Health Center Enrollment ENGLISH
• School Based Health Center Enrollment SPANISH

Financial

• Sliding Fee Application ENGLISH
• Sliding Fee Application SPANISH
• Sliding Fee Application CREOLE
• Sliding Fee Application and Pt Agreement ENGLISH
• Sliding Fee Application and Pt Agreement SPANISH
• Sliding Fee Application and Pt Agreement CREOLE
• Pt Financial Responsibility Form ENGLISH
• Pt Financial Responsibility Form SPANISH
• Consents and Assignments ENGLISH
• Consents and Assignements SPANISH
• CCHS HIPAA Notice of Privacy Practices