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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
Click Here for New Patient Forms in Spanish

Consent Forms:
Authorization to Disclose/Release of Information
Patient Portal Consent
Patient Information Release
Notice of Privacy Practices
Initiation of Services
Consent for Email/Text

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