ADULT NEW PATIENT PACKET

Services Available by Location

Sliding Fee Scale

HIPAA Notice of Privacy

FQHC Survey *

Health History Form *

Consent to Discuss PHI *

Consent for Treatment *

HIXNY Consent Form *

HealthEConnections Consent Form *

Psychosocial Needs Assessment *

Telehealth Consent Form *

Forms marked with a * are required to be filled out prior to your visit.