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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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