HCHC
  • Home
  • Services
    • Medical Health Care
      • Family Medicine
      • Women’s Healthcare
        • Family Planning
        • Prenatal Care
      • Pediatric Care
    • Behavioral Health Care
      • Counseling
    • Dental Care
    • Pharmacy
  • About Us
    • Our Providers
    • Mission, Vision, Values
    • Board of Directors
    • Patient Centered Medical Home
    • Impact Report
  • Careers
  • For Patients
    • Patient Portal
    • New Patients
    • Affordable Care
    • Patient Education & Resources
  • Our Locations
    • HCHC Pharmacy
    • Stone Port
    • Park View
    • Elkton
    • Downtown
    • Care Management
  • News
  • Contact Us
  • Patient Portal
  • Donate
  • Menu Menu

Archive for: Documents and Forms

You are here: Home1 / Documents and Forms

Notice of Privacy Practices

Income Self-Declaration Form

Letter of Support Form

Employment Verification Form

Sliding Fee Application

New Patient Paperwork

Contact Us

Have Questions? Get In Touch!

For general inquiries, access to your private medical information, or scheduling needs contact us using the following methods.

Give us a call

540.433.4913

For Current Patients

Patient Portal

For New Patients

Pre-Register Online
hchc logo
  • 540.433.4913
  • Get In Touch
Patient Portal
  • Facebook

Quick Links

  • Notice of Privacy Practices
  • Accessibility Statement
  • Patient Education & Resources
  • Affordable Care
  • Careers
  • HCHC Store
Donate

Join Our Newsletter

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
hrsa-logo

This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

© Copyright Healthy Community Health Centers. Web Design & Development by Estland.
Scroll to top