Patient Registration Forms

In order to streamline your patient experience, CHCCW encourages you to fill out our online patient registration forms prior to your visit.

Click the links below to access our Patient Registration Forms for each clinic location.

Dental Form

Our Dental Clinic utilizes separate patient registration forms. Visit our dental page to access these forms.

Sliding Fee scale

Sliding Fee Scale forms and information are available on our Sliding Fee Application page.

Medical Records Release

Download our Medical Records Release Form