COVID-19 Update: CCHC is committed to continue providing high-quality care to all of our patients throughout the coronavirus pandemic. To keep everyone safe, we cannot accept walk-in patients right now. Patients who do not have an appointment will not be seen. If you are a CCHC patient, please call ahead or use your MyChart patient portal to make an appointment.
For Patients
For Existing patients
Looking for high-quality, patient-centered care?
Patient Forms
Looking for something specific ? Find all our patient forms in English and Spanish here.
If you’ve never been seen at CCHC before and want to receive medical, dental, or behavioral health services at CCHC, fill out the New Patient Application – English or New Patient Application – Spanish. All new patients, regardless of insurance, need to complete a New Patient Application. See more information about the process on our Become a Patient page.
If you receive a sliding scale discount for your visits, you need to complete a Renewal Application – English or Renewal Application – Spanish before the expiration date listed on your CCHC patient card.
All patients need to complete a Notice of Private Policy Receipt – English or a Notice of Private Policy Receipt – Spanish once a year.
The Health Insurance Portability and Accountability Act (HIPAA) regulates who we can tell information about your health. If you would like CCHC to be able to talk with someone other than you about your health, like your parent or your spouse, fill out the HIPAA Release – English or HIPAA Release – Spanish.
If family or friends are supporting you financially because you are not currently working, have your friend or family member fill out and sign a Letter of Support – English or Letter of Support – Spanish.
If you don’t receive pay stubs because your employer pays you in cash, have your employer fill out and sign a Employer Income Verification Form.
If you want to send your medical records from CCHC to another organization, like a different doctor’s office or a lawyer, fill out the Medical Records Release from CCHC.
If you want another organization, like a hospital or a former doctor’s office, to send your medical records to CCHC, fill out the Medical Records Release to CCHC.