Patient Forms

Patient Forms We offer these forms which can be saved and/or printed for your convenience:

Sliding Fee Scale Brochure
Patient Information Form
New Patient Registration Forms - Ages 0-17
New Patient Registration Forms - Adults
Treatment of Minors Consent Form
CHCGD Release of Medical Information Form
Discount Prescription (340B) Program Brochure
Billing Agreement
Sliding Fee Scale Application
CHCGD Printable Brochure
Patient Resource List
CHCGD Notice of Privacy Practices
DPS & Mobile Health Unit Consent Form
DPS Mobile Health Unit Brochure