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

Adult
Registration Form (English)

Pediatrics
Registration Form (English)

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)

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)