Patient Portal
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Patient Forms
Affordable healthcare near you, made easy.
New Patient
If you are a new HealthReach patient, please fill out and sign two forms: the Authorization to Disclose Healthcare Information form and the General Consent to Treat form.
Authorization to Disclose Healthcare Information
The Authorization to Disclose Healthcare Information allows us to get your medical records from your previous primary care provider.
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.
Affordable Care Program
If you would like to apply for financial assistance for healthcare and/or dental services, click below.
General Information
Finally, you may read HealthReach’s Patient Bill of Rights and Responsibilities and the HealthReach Notice of Privacy Practices. You do not need to return these forms.
Patient Bill of Rights and Responsibilities
Declaración de Derechos y Responsabilidades del Paciente
HealthReach Notice of Privacy Practices
HealthReach Aviso de Prácticas de Privacidad
Your local healthcare center may request you complete additional forms. These will be provided to you either before or at your appointment.