Patient Forms
Make Your Visit As Smooth & Efficient As Possible
Conveniently access our new patient forms to make your first visit to PureView Health Center as smooth and efficient as possible. Click the appropriate button to access our forms in the Portable Document Format (PDF), which requires Adobe’s Acrobat Reader.
Save time and avoid unnecessary delays
- Find the appropriate form
- Print the form
- Fill out the form
- Bring the forms with you to your appointment
Intake Forms
School-Based Care
Other Forms
Sliding Fee Discount Program Application (PDF Version)
Medical Records Release of Information (PDF Version)
Medical Records Change Request Form (PDF Version)
General Authorization For Disclosure of Health Information (PDF Version)
HCH Enrollment Form (PDF Version)
Affidavit of Financial Status (PDF Version)
Welcome Brochure 2024 / PCMH Information (PDF Version)

Contact Us Today To Schedule Your Visit. Let's Embark On A Journey To Better Health Together.