Our goal is to always provide you with the best possible patient experience. To help you, we have provided registration paperwork below that you can fill out prior to your visit. Once you have completed these forms, please print and bring them with you to your appointment.
Once you have completed these forms, please print and bring them with you to your appointment. If you have any questions regarding the paperwork, please feel free to contact the location you intend to visit and the staff there will assist you in any way possible.
| Image | Title | Language | Document Link | hf:tax:facility |
|---|---|---|---|---|
 | CHP Private Practices | English | advanced-laparoscopic-surgical-associates california-urology-north-fresno community-diabetes-endocrine-specialists community-gynecologic-oncology-specialists community-maternal-fetal-medicine-ladella community-maternal-fetal-medicine-visalia community-medical-oncology-specialists community-neurosciences-institute-%c2%b7-clovis community-neurosciences-institute-%c2%b7-downtown community-neurosciences-institute-%c2%b7-fresno community-neurosciences-institute-%c2%b7-river-park community-neurosciences-institute-%c2%b7-visalia community-obstetrics-gynecology-care-lura-reddington-m-d community-pediatric-care community-pediatric-specialists community-perinatology community-primary-care community-primary-care-dr-fayed community-primary-care-fir-south community-primary-care-herndon community-primary-care-milburn community-primary-care-shaw community-primary-care-dr-kuebrich-arreola community-primary-care-%c2%b7-alluvial community-primary-care-%c2%b7-halifax community-primary-care-sussex-way community-radiation-oncology-specialists community-rheumatology-specialists community-specialty-surgery-associates community-urology-specialists copeland-medical-healthcare-partners-a-member-of-community-health-partners dizon-medicine-a-member-of-community-health-partners m2-oncology sierra-endocrine-associates valley-surgical-specialists | |
| CHP Privacy Practices | Spanish | advanced-laparoscopic-surgical-associates california-urology-north-fresno community-diabetes-endocrine-specialists community-gynecologic-oncology-specialists community-maternal-fetal-medicine-ladella community-maternal-fetal-medicine-visalia community-medical-oncology-specialists community-neurosciences-institute-%c2%b7-clovis community-neurosciences-institute-%c2%b7-downtown community-neurosciences-institute-%c2%b7-fresno community-neurosciences-institute-%c2%b7-river-park community-neurosciences-institute-%c2%b7-visalia community-obstetrics-gynecology-care-lura-reddington-m-d community-pediatric-care community-pediatric-specialists community-perinatology community-primary-care community-primary-care-dr-fayed community-primary-care-fir-south community-primary-care-herndon community-primary-care-milburn community-primary-care-shaw community-primary-care-dr-kuebrich-arreola community-primary-care-%c2%b7-alluvial community-primary-care-%c2%b7-halifax community-primary-care-sussex-way community-radiation-oncology-specialists community-rheumatology-specialists community-specialty-surgery-associates community-urology-specialists copeland-medical-healthcare-partners-a-member-of-community-health-partners dizon-medicine-a-member-of-community-health-partners m2-oncology sierra-endocrine-associates valley-surgical-specialists | |
| Health History & Consent for Treatment | Spanish | community-pediatric-specialists | |
| Health History & Consent for Treatment | English | community-pediatric-specialists | |
| New Patient Packet | Spanish | community-pediatric-specialists | |
| New Patient Packet | Spanish | m2-oncology | |
| New Patient Packet | Spanish | community-medical-oncology-specialists | |
| New Patient Packet | Spanish | community-gynecologic-oncology-specialists | |
| New Patient Packet | Spanish | community-perinatology | |
| New Patient Packet | Spanish | community-specialty-surgery-associates | |
| New Patient Packet | Spanish | community-primary-care-dr-fayed community-primary-care-dr-kuebrich-arreola | |
| New Patient Packet | Spanish | community-maternal-fetal-medicine-ladella | |
| New Patient Packet | Spanish | community-neurosciences-institute-%c2%b7-clovis | |
| New Patient Packet | Spanish | community-neurosciences-institute-%c2%b7-fresno | |
| New Patient Packet | Spanish | community-neurosciences-institute-%c2%b7-river-park | |
| New Patient Packet | Spanish | community-primary-care-sussex-way | |
| New Patient Packet | Spanish | community-primary-care-%c2%b7-halifax | |
| New Patient Packet | Spanish | copeland-medical-healthcare-partners-a-member-of-community-health-partners | |
| New Patient Packet | Spanish | community-primary-care-%c2%b7-alluvial | |
| New Patient Packet | Spanish | community-diabetes-endocrine-specialists | |
| Fax Referral | English | community-diabetes-endocrine-specialists | |
| New Patient Packet | Spanish | community-primary-care | |
| New Patient Packet | Spanish | sierra-endocrine-associates | |
| New Patient Packet | Spanish | community-urology-specialists | |
| CNI Fresno Referral Form | English | community-neurosciences-institute-%c2%b7-fresno | |
| New Patient Packet | Spanish | community-neurosciences-institute-%c2%b7-visalia | |
| CNI Visalia Referral Form | English | community-neurosciences-institute-%c2%b7-visalia | |
| New Patient Packet | Spanish | community-primary-care-milburn | |
| New Patient Packet | Spanish | community-rheumatology-specialists | |
| Fax Referral | English | community-rheumatology-specialists | |
| New Patient Packet | Spanish | community-pediatric-care | |
| Pediatric Health History Questionnaire | English | community-pediatric-care | |
| New Patient Packet | Spanish | advanced-laparoscopic-surgical-associates | |
| New Patient Packet | Spanish | valley-surgical-specialists | |
| New Patient Packet | Spanish | community-radiation-oncology-specialists | |
| New Patient Packet | Spanish | community-obstetrics-gynecology-care-lura-reddington-m-d | |
| New Patient Packet | Spanish | community-primary-care-fir-south | |
| New Patient Packet | Spanish | california-urology-north-fresno | |
| New Packet Packet | Spanish | community-primary-care-herndon | |
| Fax Referral Form | English | california-urology-north-fresno | |
| Sleep Questionnaire – Spanish | Spanish | community-pediatric-specialists | |
| Sleep Questionnaire – English | English | community-pediatric-specialists | |
| New Patient Packet | Spanish | dizon-medicine-a-member-of-community-health-partners | |
| Agreement-Authorization for Services Consent – Required | English | dizon-medicine-a-member-of-community-health-partners | |
| Open Payments Release – Required | English | dizon-medicine-a-member-of-community-health-partners | |
| Adult Health Questionnaire – Required | English | dizon-medicine-a-member-of-community-health-partners | |
| Medication Agreement – Required | English | dizon-medicine-a-member-of-community-health-partners | |
| Fax Referral Form | English | community-maternal-fetal-medicine-ladella | |
| New Patient Packet | Spanish | community-maternal-fetal-medicine-visalia | |
| New Patient Packet | Spanish | community-neurosciences-institute-%c2%b7-downtown | |
| New Patient Packet | English | advanced-laparoscopic-surgical-associates california-urology-north-fresno community-diabetes-endocrine-specialists community-gynecologic-oncology-specialists community-maternal-fetal-medicine-ladella community-maternal-fetal-medicine-visalia community-medical-oncology-specialists community-neurosciences-institute-%c2%b7-clovis community-neurosciences-institute-%c2%b7-downtown community-neurosciences-institute-%c2%b7-fresno community-neurosciences-institute-%c2%b7-river-park community-neurosciences-institute-%c2%b7-visalia community-obstetrics-gynecology-care-lura-reddington-m-d community-pediatric-care community-pediatric-specialists community-perinatology community-primary-care community-primary-care-dr-fayed community-primary-care-fir-south community-primary-care-herndon community-primary-care-milburn community-primary-care-shaw community-primary-care-dr-kuebrich-arreola community-primary-care-%c2%b7-alluvial community-primary-care-%c2%b7-halifax community-primary-care-sussex-way community-radiation-oncology-specialists community-rheumatology-specialists community-specialty-surgery-associates community-urology-specialists copeland-medical-healthcare-partners-a-member-of-community-health-partners dizon-medicine-a-member-of-community-health-partners m2-oncology sierra-endocrine-associates valley-surgical-specialists | |
| CHP Authorization Release – PHI | English | advanced-laparoscopic-surgical-associates california-urology-north-fresno community-diabetes-endocrine-specialists community-gynecologic-oncology-specialists community-maternal-fetal-medicine-ladella community-maternal-fetal-medicine-visalia community-medical-oncology-specialists community-neurosciences-institute-%c2%b7-clovis community-neurosciences-institute-%c2%b7-downtown community-neurosciences-institute-%c2%b7-fresno community-neurosciences-institute-%c2%b7-river-park community-neurosciences-institute-%c2%b7-visalia community-obstetrics-gynecology-care-lura-reddington-m-d community-pediatric-care community-pediatric-specialists community-perinatology community-primary-care community-primary-care-dr-fayed community-primary-care-fir-south community-primary-care-herndon community-primary-care-milburn community-primary-care-shaw community-primary-care-dr-kuebrich-arreola community-primary-care-%c2%b7-alluvial community-primary-care-%c2%b7-halifax community-primary-care-sussex-way community-radiation-oncology-specialists community-rheumatology-specialists community-specialty-surgery-associates community-urology-specialists copeland-medical-healthcare-partners-a-member-of-community-health-partners dizon-medicine-a-member-of-community-health-partners m2-oncology sierra-endocrine-associates valley-surgical-specialists |
Please do not email these forms to your provider or the location you intend to visit. Email communication is not secure and your protected health information (PHI) may be intercepted or compromised by people other than the intended recipient.
Things to bring with you to your appointment:
Thank you for trusting Community Health Partners with your care!