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New Patient Forms

Please print and complete the new patient packet. To complete your registration, we will need a picture of your photo ID and Insurance Card if you have one. Please fax or email the completed forms and cards to our Care Connection Team:
Secure fax- 888-530-3638
Email- careconnectionteam@cancommunityhealth.org

If you are unable to complete these forms prior to your visit, please arrive at least 15 minutes in advance of your appointment to complete them in our office.  Thank you again for choosing CAN Community Health to provide your care. Please click here for download and email instructions

Please Click here to Download the New Patient Forms
Haga Clic aquí para ver los Formularios para Pacientes Nuevos en Español

Individual Forms
Authorization to Disclose
Initiation of Services
Patient Consents
Patient Self-Determination Questionnaire

When it comes to your health information, you have certain rights.
Click the link below for an explanation of your rights and some of our responsibilities to help you

Download the Patient Rights PDF
Click Here for Patient Rights in Spanish

We work hard every day to provide the highest quality and most caring service to our visitors. We care about your experience in our clinics. If for any reason you would like to file a formal complaint please follow this Grievance Procedure:

Grievance Procedure

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