Here you will find the personal forms you need for your visit with us. Downloading these forms and filling them out before you come for your appointment will help save you time.

Please complete the following forms and bring them with you at the time of your appointment. Please do not mail or fax them as they will not be accepted.

Request for Medical Services (all clients)
Patient Registration (all clients)
Patient Registration - Spanish (all clients)
Medical History Form (female clients only)

SelectPlan Application

All forms are in PDF format, so you will need Acrobat Reader to open them. If you do not have Acrobat Reader installed on your computer, you can download it here.

Questions?

If you have any questions about how to do this, you may contact your nearest Health Center or call 1-800-230-PLAN to be connected to the Health Center closest to you.