Sitio en Español Sitio en Español
Your health is our mission.
304.263.4999

Patient Forms

Primary Care – Adult and Pediatrics

New Patient Packet - English
New Patient Packet – Spanish

Women’s Health

New Patient Packet - English
New Patient Packet – Spanish

Behavioral Health

Children’s Intake Packet
Adult Intake Packet

Oral Health

New Patient Packet – English
New Patient Packet - Spanish

Additional Forms

Release of Information – English and Spanish Combined
Consent for Healthcare for a Minor – English
Consent for Healthcare for a Minor – Spanish

Sliding Fee

Brochure - English
Brochure - Spanish
Cover Letter - English
Cover Letter - Spanish
Application - English
Application - Spanish
Joint Commision Quality Control
FQHA
Quality Leader Badge