New Patient Information

Are you a new patient? Make sure to read the following information.

Yes, we accept most carriers.

Yes, you do not have to be insured to be seen.

If you are a new patient you will be screened for program eligibility and will need to bring the following documents.

Our knowledgeable staff will provide guidance and assistance to determine which programs you may qualify for.

Identification (ID)

You will need to bring a form of identification. (ID, Driver's License, Passport)

  • ID
  • Driver's License
  • Passport

Proof Of Income

You will need to bring one (1) check stub issued within the last thirty (30) days.

  • One Check Stub

Proof Of Address

You will need to provide proof of your address, preferably with a utility bill.

  • Utility Bill
  • Lease

Proof for Dependents

You will need to bring proof for your dependents. Social Security Numbers (SSN) and Birth Certificates.

  • Social Security Cards
  • Birth Certificates

Medications

Please bring all the medications you are prescribed to your visit.

  • Any Prescriptions
  • Any Over The Counter Medication

Shot Records

Please bring your shot records to your visit. This applies to both adults and children.

  • Vaccine Records

Online Registration is available.

To expedite patient screening, CHCL is providing digital versions of the screening forms. You will need to fill out all of the following forms. 

  • Enrollment Form
  • Consent To Treatment Form
  • Patient & Center Rights and Responsibilities Form
  • Learning Assessment Form
  • Migrant Seasonal Determination Form
  • Notice of Privacy Practices Form
  • Privacy Health Care Services Program Form
  • Patient Portal Consent Form
  • Telehealth/Telemedicine Form

The Online Registration will walk you through the process and display your completion progress. Once you submit your completed forms, our staff will receive them and begin registration for you. 

Online Registration