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Patient Forms

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New Patient Forms

Many documents that are needed for new patient registration or that are regularly requested of our patients are available here for printing and filling out at home at your convenience. Assistance in filling out any of the forms are available at any of our clinics during normal business hours.

SDH Screening Forms:

Please click one of the following buttons to fill out a digital form corresponding to your needs:

Haga clic en uno de los siguientes botones para completar un formulario digital correspondiente a sus necesidades:

SDH Screen (Adult)
SDH Screen Youth (0-18)
SDH (Adulto)
SDH Juventud (0-18)

Waterfall Information & Patient Registration

Click to download this form.

New Patient Welcome Form - English

Click to download this form.

New Patient Welcome Form - Spanish

Click to download this form.

Patient Registration - Spanish

Click to download this form.

Health History Questionnaire

Click to download this form.

Patient Information, Rights and Resonsibilities

Click to download this form.

Records Release Form

Click to download this form.

Medical Information Release - Spanish

Click to download this form.

Sliding Discount Fee Schedule Information & Application

Click to download this form.

Waterfall Policies & MyChart Information

Click to download this form.

Rights and Responsibilities - Spanish

Click to download this form.

Notice of Privacy Practices

Click to download this form.

Starfish Youth Therapy Center Fax Referral Form

Click to download this form.