New Patient Process

Become a HealthReach Patient in a few easy steps.

1. Call your local health center to request that a New Patient Packet be mailed to you.

OR

Print the Authorization to Disclose Healthcare Information form and the General Consent to Treat form.

2. Mail, fax, or drop off the forms to your local health center.

3. Reach out to your current Primary Care Provider to ensure you have a minimum of 6 months of medication refills prepared. HealthReach new appointment wait times may vary. This is also a good time to let them know that they’ll be receiving a request for records from a new provider. This conversation is not mandatory, but can ensure we receive your records in a timely manner.

4. Once the health center receives your records from your former primary care provider, you will receive a call to set up your new patient appointment.

Patient Forms

Authorization to Disclose Healthcare Information

Authorization to Disclose Healthcare Information allows us to get your medical records from your previous primary care provider.

Autorización Para Divulgar Información de Atención Médica

Autorisation de Divulguer des Renseignments de Soins de Santé 

General Consent to Treat

The General Consent to Treat form allows us to treat you or a patient for whom you are the legal guardian.

Formulario de consentimiento general para tratamiento médico traducido al español.

Formulaire de consentement général pour un traitement médical, traduit en français.

نموذج الموافقة العامة على العلاج مترجم إلى اللغة العربية.

Permission to Share Protected Health Information

The Permission to Share Protected Health Information (P.H.I.) form allows us to verbally share information of your choosing with a friend, family member, or person assisting in your care or payment for your care.

Formulario de autorización para compartir información de salud protegida, traducido al español.

Formulaire d’autorisation de partage d’informations de santé protégées, traduit en français.

Affordable Care Program Application 

The HealthReach Affordable Care Application allows you to apply for financial assistance for health and dental services.

General Information

Patient Bill of Rights and Responsibilities

The Patient Bill of Rights and Responsibilities explains the rights and responsibilities that you have within the healthcare setting.

Declaración de Derechos y Responsabilidades del Paciente

Notice of Privacy Practices

The HealthReach Notice of Privacy Practices describes how your medical information may be used and disclosed, and how you can obtain this information.

HealthReach Aviso de Prácticas de Privacidad

Avis de HealthReach Concernant les Pratiques en Matière de Confidentialité

Your local health center may request you complete additional forms. These will be provided to you either before or at your appointment.