Patient Forms
Forms for New Patients
- Nondiscrimination Policy
- CAIR Immunization Registry
- Vaccine Policy
- PCHA Notice of Privacy Practices
- Privacy Notice Signature Page
- Family History
- MyChart Proxy
- Conditions of Registration
Forms for Established Patients
- ADHD Packet - English
- ADHD Packet - Spanish
- ADHD Questionnaires
- California State Health Exam Form
- Caretaker Authorization Form
- Preschool Form
- Over 18 year old Patient Information Form
- Authorization for Release of Health Information Form - English
- Authorization for Release of Health Information Form - Spanish
Well Visit Questionnaire Forms
- 2 Week Visit
- 1 Month Visit
- 2 Month Visit
- 4 Month Visit
- 6 Month Visit
- 9 Month Visit
- 12 Month Visit
- 15 Month Visit
- 18 Month Visit
- 2 Year Visit
- 2.5 Year Visit
- 3 Year Visit
- 4 Year Visit
- 5 Year Visit
- 6 Year Visit
- 7 Year Visit
- 8 Year Visit
- 9-11 Year Visit
- 12-17 Year Visit
- 18 and over Year Visit
- MCHAT English
- MCHAT Spanish
