Bartz-Altadonna Community Health Center
  • 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
    • Hall of Flame
  • Registration Forms
  • Contact Us
  • For Patients
    • MyChart
    • Immunization Records
    • Education
  • More
    • 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
      • Hall of Flame
    • 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
Sliding fee application (pdf)Download
Forma de registro para nuevo paciente (pdf)Download
Forma de aplicacion para escala de descuento (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

Copyright © 2020 Bartz-Altadonna Community Health Center - All Rights Reserved.

  • Home
  • Mobile Unit
  • Donate
  • Privacy Practice
  • Registration Forms
  • Contact Us
  • MyChart
  • Employee Remote Access