Forms – New Patient – Release of Information – Eligibility

New Patient Forms

If you are a new patient, you will need to complete the form below before seeing a health care provider. Print and fill out the New Patient Form in the comfort of your home and avoid having to come 30 minutes earlier for your appointment to do paperwork.

New Adult Patient Form
Adult Medical History Form
New Child Patient Form
New Child Medical History Form

Eligibility Forms

An eligibility appointment is very important in order to assess whether or not you qualify for various programs and/or financial aid from the government. Our Eligibility Specialists are highly-trained and will match you with the best options you have so that you will benefit from the most affordable health care solution.

Eligibility Requirements for Montrose Campus
Eligibility Requirements for Lyons Campus
Eligibility Requirements for Southwest Campus
Eligibility Requirements for South Park Campus

Patient Contract

We take our responsibility towards you as a patient very seriously and expect the same in return. Please read the “Patient Contract” to understand our expectations of you and our commitment to you.

Patient Contract

Release of Information (ROI) Authorization

ROI Form – English
ROI Form – Spanish

Consent for Non-Parent

Consent Form – English 
Consent Form – Spanish