New patient forms

To save time, print and complete these forms. Bring them with you to your first appointment. For school-based registration, see the specific page for the school-based health center you want to register for.

Patient Registration 

Consent for Care and Treatment

Medical patients 

Dental patients

Review our Notice of Privacy Practices 

MyChart Forms

Print and complete this form to request proxy access to a child's MyChart account (proxy means representing someone else) and give it to the front desk at your child's next appointment at the clinic. Read more about proxy access on the MyChart page.

Sliding fee discount application

If you do not have health insurance or are underinsured, we can help you understand your options for applying for insurance and other assistance programs available regardless of income or immigration status. One of those programs is our sliding fee discount program based on household size and income. Call to make a free appointment with one of our eligibility specialists. Visit the sliding fee discount program page for application forms. 

Behavioral Health

Before your behavioral health phone visit, please click on the links below, answer the questions, and write down your total scores for each questionnaire. Give the two scores to your behavioral health provider during your visit.

You may also complete these questionnaires by printing a paper version:

Nutrition Counseling

Our dietitian nutritionists can help patients of all ages and from all cultures change their eating habits to improve their health. Appointments are free for Neighborcare Health patients.

Please view, download and/or print the materials below as requested by your care team:

Other resources

Breast cancer screening and mammogram locations