Partnership Health Center
To better serve you, we have provided the following new patient forms on-line. To access any of the forms, please click on the appropriate button. Then print out the form, fill it out, and bring it with you when you come for your appointment.
The following forms are in the "Portable Document Format" (.pdf) and requires Adobe's Acrobat Reader.
- Patient Information - ALL Patients (PDF Version) (Microsoft Word Version)
- Sliding Fee Scale - ALL Patients (PDF Version) (Microsoft Word Version)
- HIPAA - ALL Patients - Health Insurance Portability and Accountability Act (PDF Version) (Microsoft Word Version)
- Dental Patient Contract - dental patients only (PDF Version) (Microsoft Word Version)
- Parental Consent - Required if a parent or legal guardian will not be present for an appointment. Completed and signed copies of all Intake Forms will also need to be submitted prior to the appointment, along with copies of any insurance cards.
- Release of Information Form - Medical Records Request
- Release of Information Form - Dental Records Request