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Patient Registration

New Patient Forms

If you are a new patient at Community Health Alliance, please review our welcome letter in English or Spanish.

Prior to your appointment, please download and complete the following forms in each section and bring them in person. These forms will be available at your appointment if you are unable to download and print at home.

For Adult Patients

English

  1. Registration Form (English)
  2. Adult Health History Packet (English)

Spanish

  1. Registration Form (Spanish)
  2. Adult Health History Packet (Spanish)

For Pediatric Patients

English

  1. Registration Form (English)
  2. Pediatric Health History (0-11yr) (English)
  3. Pediatric Health History (12-18yr) (English)

Spanish

  1. Registration Form (Spanish)
  2. Pediatric Health History (0-11yr) (Spanish)
  3. Pediatric Health History (12-18yr) (Spanish)

Sliding Fee Scale Application and Guidelines

Please fill out the sliding fee scale application and bring it with your other forms on the day of registration.

You can review a copy of our 2021-2022 sliding scale fee and federal guidelines.


Review Community Health Alliance’s Notice of Privacy Policy. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Para consultar Aviso de Política de Privacidad de Community Health Alliance. Esta notificación describe cómo puede utilizarse y divulgarse su información médica, y cómo puede acceder usted a esta información. Revísela con cuidado.

Become a Patient

Request an appointment online or call us to schedule an appointment at a location near you.

Thank you for being my doctor!

Your clinic helps so many people and moves them through very efficiently.  I never mind waiting because I know you are helping someone.  And, when you come in to see me you always give me your full attention, as if I am your only patient.  Your good will and positive intent always shine through. Thank you for being my doctor.

Steven H.

I feel like I just walked in and won the lottery.

I feel like I just walked in and won the lottery…I lost one tooth 2 years ago and I was heartbroken and said I never wanna lose a tooth again. I have been so scared that I would not be able to afford my teeth and now I know I can! I am so so so happy! Thank you thank you thank you from the bottom of my heart!

Michelle
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