PATIENT PORTAL

PLEASE READ THE INSTRUCTIONS CAREFULLY
Step 1 – Read the information below
Step 2 – Complete the Patient registration Form

Please call our facility if you have any question. A healthcare professional is always available to answer your questions.

What to bring to facility 
The following will be needed for all household members (if applicable):

  • Photo Identification
  • Three (3) Proof of Income for all household members dated within the last 60 days; required for all uninsured patients that wish to utilize our sliding fee discount for charges applied to the deductible or non-covered charges.


In case of emergency contact

INFORMATION FOR MINOR PATIENTS ONLY

If you are completing this form as a parent or guardian, list children below from oldest to youngest in the household


PLEASE READ CAREFULLY:
Notice of Privacy Practices
CCIHS'S Patient Rights and Responsibilities
New Patient only: How did you find out about Central Care Community Health Center?

Type the character you see on the image (CasE SeNsiTiVe)