Minor New Patient Packet

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Community Health Center of the North Country | Canton
Phone: (315) 386-8191
Fax: (315) 386-1410

Community Health Center of North Country | Malone
Phone: (518) 483-0109
Fax: (518) 483-0115

Community Health Center of North Country | Watertown
Phone: (315) 786-0983
Fax: (315) 786-0994

Community Health Center of the North Country | Gouverneur
Phone: (315) 287-4440
Fax: (315) 287-1858

Community Health Center of the North Country | Ogdensburg
Phone: (315) 713-9350
Fax: (315) 713-9351

Welcome to Our Practice

Services Available by Location

Sliding Fee Scale

HIPAA Notice of Privacy

FQHC Survey *

Health History Form *

Consent to Discuss & Accompany *

Consent for Treatment *

HIXNY Consent Form *

HealthEConnections Consent Form *

Telehealth Consent Form *

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