Patient Forms
Registration Forms
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 Forms
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.
Confidential Health Questionnaire Forms
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 Forms
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 Forms
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.