Tri-Area Community Health Center at Laurel Fork

Forms

The following forms have been provided for your convenience and may be referred to for additional information regarding our services and procedures.

Patient Forms

• Patient Registration Form (PDF document)
• Authorization for Release of Information (PDF document)
• Office Policies for New Patients (PDF document)
• Patient Medical Questionnaire (PDF document)
• Permission to Discuss Patient History Information Form (PDF document)

Financial Forms

• 2009 Application and Income Guidelines (PDF document)
• Payment Policy (PDF document)

Pediatrics and Well Child

• 0-6 Years Immunization Schedule (PDF document)
• 7-18 Years Immunization Schedule (PDF document)