New Patient Packet
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. Appointments: Please call 330-363-6242 for the Canton office or 234-386-0306 for the Magnolia office to schedule an appointment. 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 Forms
- Notice of Privacy Practices
- Patient Agreement
- Privacy Communication Worksheet
- Consent to Treat Minor Worksheet (complete for patients under 18)
