Preparing for a Clinic Visit

If you are a new patient, the following documents are available for review, printing and completion prior to your clinic visit.  To save time, you are encouraged to bring these completed forms with you to your appointment.  You can find these in our Forms & Downloads section.

Forms available online:

(New Patients) Each registration form package will contain:

  • Full Registration Form
  • Patient Health History Form
  • Patient Demographics Form - UDS
  • Privacy Practices Notice
  • Acknowledgement of Receipt of Privacy/HIPAA Notice  View Privacy Notice
  • California Immunization Registry Consent Form (if needed)
     

For every appointment with CHC:

Bring With You

  1. Your insurance card
  2. A list of current medications including over the counter and vitamins
  3. A description of the problem, how long you have had it and how it affects you

Medical Records

  • Please bring a copy of recent medical records or be prepared to fill out a summary of your health status, personal and family history, any recent labs or x-rays if available.

Laboratory and
Diagnostic Tests

  • CHC has a draw station at most clinics. Samples are sent to UDL 

Prescriptions

  • Please provide your pharmacy with name and address
  • Refills should be handled by fax request
  • If you have questions about a new prescription or about discontinuing medications, you can call to speak to your Care Team.

Payment

  • We accept cash, checks or credit cards for payment in full and co-pays. In most cases, a payment arrangement can be made by calling the CHC Billing Department. There are also a variety of programs that may help you qualify for health care at limited or no cost to you.


Items to note before your appointment:

  • You must be registered for each clinic visit or before having a test.  Having the appropriate forms filled out before your visit will reduce your total visit time.
  • Please allow for time to park; parking availability varies with each clinic location.
  • Clinic registration is done by appointment time.  To decrease your overall waiting time, we recommend that you do not arrive more than 30 minutes prior to your appointment.

If you require additional information, please contact the specific clinic.  Clinic Contact List