Registration Form – RA1 (English)
Registration Form – RA2 (Spanish)

Note: These forms are for new patients to complete. Please print the form, fill it out, sign your name and bring to your clinic appointment.

Medical Record Form – MR1 (English)
Medical Record Form – MR2 (Spanish)

Note: Complete this form to ask for your medical records. Please print the form, fill it out, sign your name and bring to the clinic.

Adult Forms

Confidential Health Questionnaire Form – CHA1 (English)
Confidential Health Questionnaire Form – CHA2 (Spanish)

Senior Forms

Confidential Health Questionnaire Form – CHS1 (English)
Confidential Health Questionnaire Form – CHS2 (Spanish)

Note: Complete this form to give us more details about your health. Please print the form, fill it out, sign your name and bring to the clinic.

Patient Consent Form – PC1 (English)
Patient Consent Form – PC2 (Spanish)

Note: This form provides consent to the treatment and services provided by VCH. Please print the form, fill it out, sign your name and bring to the clinic.

Health Risk Assessment Form – HRA1 (English)
Health Risk Assessment Form – HRA2 (Spanish)

Note: Complete this form to give us more details about your health. Please print the form, fill it out, sign your name and bring to the clinic.