Forms

Medical

• New Patient NO Insurance
• New Patient with Insurance
• Teen Clinic

Dental

• New Patient Dental Paperwork

Please print out and complete this paperwork, and then bring it with you to your appointment.

• • Consent to treat a minor

This form gives CHC legal permission to treat your child in case you cannot accompany him or her to CHC for treatment.

• Privacy Practices

This describes how your medical information may be used and/or disclosed and how you can get access to your medical information

 

• Authorization to Release or Request Medical Records

Community Health Connection release of medical information can be used to request a copy of your medical records.

 

• Employment Application

Please complete and email jobs@communityhealthconnection.org or fax to 918.442.2036 if you are interested in any of our current employment opportunities.

 

• Board of Directors Application
• Board of Directors Orientation Packet

Please complete and email boardchair@communityhealthconnection.org or fax to 918.442.2011 if you are interested in becoming a member of our Board of Directors.