Patients

Patient Forms

Please take a few minutes to print and complete the Patient Registration Form to minimize your wait time in our office. If you are a parent of a minor, please also complete the Parental/Legal Guardian Authorization to Treat a Minor. If you are uninsured or need financial assistance with your visit, please complete the Sliding Fee Scale Eligibility Documentation Form. Please complete all the necessary forms and bring them to your appointment along with your photo ID, Social Security Card, current insurance card, proof of income (if uninsured) and a list of all the medications you are currently taking. Thank you for making us your Medical Home! We look forward to providing you with quality care.

Patient Registration Form

Patient Registration Form (ESPAÑOL)

CAHN Patient Policies

CAHN Patient Policies (ESPAÑOL)

Sliding Fee Scale Eligibility Documentation Form

Sliding Fee Scale Eligibility Documentation Form (ESPAÑOL)

Parental Legal Guardian Authorization to Treat a Minor

Parental Legal Guardian Authorization to Treat a Minor (ESPAÑOL)