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New Patient Registration Forms - TriCounty
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New Patient Registration Forms

If you are a new patient at Tri-County Health Center, please print and complete the forms below.

Adult Health History

Automated Outreach Preference

Medical Release Form

Patient Demographics for a Minor

Patient Demographics, Adult

Notice of Privacy Practices

Patient Agreement

Pediatric Health History Form

For patients needing financial assistance, please also complete the forms below.

Sliding Scale Discount Application

Self Declaration of Income