Online Forms

Patient Registration Form

(for completion for all patients – adults and children - before visit)

English Spanish

Sliding Fee Scale Application

English Spanish

HIPAA Protected Health Information Access Form

(optional, if you would like to give someone else access to your medical information)

English Spanish

Revocation of Consent Form

(if parent/guardian no longer wishes CHISD to receive services)

English Spanish

Consent for Treatment of CHISD Student

(for completion by parent/guardian before CHISD student visit)

English Spanish