New Patient Resources
Welcome to My Community Health Center! We are excited that you have chosen us to be your healthcare partner. We’d like you to think of us as your medical home. To help us prepare for your appointment, please review the following information and complete the forms provided below. So that we can better serve you, please arrive 15 minutes early and bring the following information with you to your appointment:
- Photo ID
- Insurance card. No insurance, no problem! Complete the Sliding Fee Scale Application and provide proof of income such as your last income tax return or your last three pay stubs.
- Medication list or prescription bottles
- New Patient Medical Intake Form (in the new patient packet)
New Patient Forms
- Notice of Privacy Practices English | Español
- Patient Agreement English | Español
- Privacy Communication Worksheet English | Español
- Consent to Treat Minor Worksheet(complete for patients under 18) English
- New Patient Packet Canton English | Español
- New Patient Packet Magnolia English | Español
- New Patient Packet Gonder English | Español
Did you know we offer pre-registration online? Save time at check-in by preregistering through the Phreesia link sent to your cell phone or email on file before your appointment!
