All new patients of our health centers will receive a New Patient Packet which contains important information for your own keeping, as well as certain forms that you or the person in your care are required to fill out before treatment. To make things easier for you, you have the option to fill out the required forms prior to your visit. These forms can be printed and filled out by hand or filled out electronically and printed off. Please bring the forms with you to your scheduled appointment. If you are unable to complete the forms prior to your visit, the forms will be provided to you at our health center.
This form allows your CHCNC clinician to access information from other individuals or agencies you currently receive or have received healthcare services from. This is an important step to managing your care because it ensures that our clinicians are fully aware of all of your healthcare needs and your health history.
If you have any questions regarding this form, please contact one of our health centers listed at the top of this webpage.
Authorization to Release Records
Autorización para divulgar registros
Authorization to Obtain Records
Autorización para obtener registros
COVID Records Release Form
Formulario de divulgación de registros COVID