Bartz-Altadonna Community Health Center
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    • Home
    • Services
      • Primary Care
      • Pediatrics
      • Obstetrics and Gynecology
      • Mobile Unit
      • Infectious Disease
      • Orthopedics
      • Behavioral Health
      • Podiatry
      • Pain Management
    • Donate
    • About Us
      • Our Mission
      • Our Story
      • Letter from our Founder
      • Our Donors
      • Governance
      • Management
      • Picture Gallery
    • Registration Forms
    • Contact Us
    • For Patients
      • MyChart
      • Immunization Records
      • Education
Bartz-Altadonna Community Health Center
  • Home
  • Services
  • Donate
  • About Us
  • Registration Forms
  • Contact Us
  • For Patients

Registration Forms

New patient registration form (pdf)Download
Forma de registro para nuevo paciente (pdf)Download
Sliding fee application (SFS) (PDF)Download
Aplicacion para escala de descuentos (SFS) (PDF)Download
Behavioral health sliding fee (PDF)Download
Pain management sliding fee (PDF)Download
Psychiatry sliding fee (PDF)Download
OB/GYN, ORTHOPEDICS Sliding fee (PDF)Download
PODIATRY, PRIMARY CARE, HOMELESS, RYAN WHITE Sliding fee (PDF)Download

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