Patient Forms

Completing these forms prior to your visit as a new patient can greatly ease your check-in process.
Click on each form to download and print it.
Forms labelled [Fillable] can be typed on before printing.
If you have any questions regarding these forms, please do not hesitate to contact our offices for assistance.

• Welcome Packet - For you to review and keep
  
  
• Welcome Packet (Spanish)
  
  
• Demographics (English and Spanish) - Must Be Completed by All Patients
  
  
• Patient Consent (English and Spanish) - Must Be Completed by All Patients
  
  
• Sliding Fee Application (English) - May be completed if you intend to apply for financial assistance through our sliding fee program.
  
  
• Sliding Fee Application (Spanish) - May be completed if you intend to apply for financial assistance through our sliding fee program.
  
  
• Employment Verification Form (English) - Used to verify employment for sliding fee applicants.
  
  
• Financial Responsibilities (English and Spanish) - Must be completed if you are applying for the sliding fee program.
  
  
• Medical Home Agreement - Required if you are a SoonerCare patient.
  
  

Dental Forms

• Dental Health History - Required if you are to be seen by our Dentists.
  
  
• Dental Patient Consent - Required if you are to be seen by our Dentists.