Click "Get your new patient application" to download an electronic copy or pick up a printed copy from any clinic location.
Once downloaded and saved to your computer, you will be able to fill out the application online by typing into the text boxes. You can then email your completed application to our front desk staff at [email protected]
Go to the Payment Options page to make sure accept your insurance or review requirements for our sliding scale program.
Complete an application for each new patient, even if they're in the same family.
Bring your completed application to any clinic location or email it to [email protected]. Don't forget to include identification and proof of income.
Applications are processed in the order that we receive them. We will call you once we process your application.
We will call to find a time that works for you and your family. Make sure you write down your appointment date and time!
Make sure you bring all your medications, your insurance card if you have one, and any pieces that were missing from your application. We look forward to welcoming you to Charlotte Community Health Clinic!
Check out our Common Questions to get an answer quickly!
