MCHC Health Centers

Download Forms

Many forms we ask you to fill out are necessary for us to provide you with the health services you want. It is important that all forms in your file are accurate and up to date so that we can give you the care you need when you need it.

Below you will find a selection of our most commonly used forms in a convenient downloadable pdf format:

All Patients:

  • Notice of Privacy Practices is given to all new patients when they register and to our loyal returning patients if the notice has changed since their last visit. También está en español.
  • Patient Feedback Form: If you would like to voice a concern about any aspect of your care, please download this form, fill it out and either bring it with you at your next visit, or mail it to the address shown. También está en español.


Patients Needing Financial Assistance:

  • If you would like to apply for sliding scale to help pay for your health care bills please sign the Sliding Scale Discount Guidelines and return to Patient Financial Services. La última página es en español.
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