Registration Forms - Community Health Systems, Inc.

Coronavirus Updates & Frequent Questions

Important Notice Due to technical issues, Bloomington Community Health Center and Bloomington Family Wellness Center are closing, Wednesday - August 5th at 12pm. Both location are expected to re-open, Thursday - August 6th with normal business hours.

Registration Forms

New Patient Packet

English

Spanish

Staying Healthy Assesment (Age)

Adult 18-55 Years Old (English)

Adult 18-55 Years Old (Spanish)

Seniors 55+ (English)

Seniors 55+ (Spanish)

0-6 Months Old (English)

0-6 Months Old (Spanish)

7-12 Months Old (English)

7-12 Months Old (Spanish)

1-2 Years Old (English)

1-2 Years Old (Spanish)

3-4 Years Old (English)

3-4 Years Old (Spanish)

5-8 Years Old (English)

5-8 Years Old (Spanish)

9-11 Years Old (English)

9-11 Years Old (Spanish)

12-17 Years Old (English)

12-17 Years Old (Spanish)

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