New Patient Information

Welcome to Tri-City Health Center 
Here, we have included forms that you can print and complete prior to your visit. This will help expedite your registration process when you arrive. We have also included our new patient handbook for you to take a look at. We look forward to seeing you! Please contact us for any other questions or concerns.

Click to download our new Patient Handbook

Registration Forms
All patients are required to complete forms.
Please print, fill out, and bring to your appointment
Registration Form (English)
Registration Form (Spanish)
Registration Form (Chinese)

Medical History
All patients are required to complete forms.
Please print, fill out, and bring to your appointment
Adult Medical History Form (English)
Adult Medical History Form (Spanish)
Adult Medical History Form (Chinese)

Pediatrics Medical History (English)
Pediatrics Medical History (Spanish)
Pediatrics Medical History (Chinese)

Immunization Consent 
(English, Spanish, Chinese)

Release of Information
This will allow us to collect your medical records from other providers and facilities.
All patients are required to complete.
Please print, fill out, and bring  to your appointment.
Medical Release (English)

Sliding Scale
All patients without insurance requesting discounted services are required to complete these forms.
Please print, fill out and bring to your appointment.
Sliding Scale Form (English)
Sliding Scale (Spanish)
Sliding Scale (Chinese)

Patient Referral Form
If you are a referred patient or going to refer a patient,
please print, fill out, and bring this form to your appointment.
Patient Referral Form (English)
Patient Referral Form (Spanish)
Patient Referral Form (Chinese)