Registration Forms - Community Health Systems, Inc.

COVID-19 Vaccines
Available

New Patients Welcome!
Get Started Here

Notice: All CHSI locations will have modified hours and will close early on Friday, March 17th. We will resume regular hours on Monday, March 20th. For specific hours, please contact your local CHSI Health Center.

Holiday Notice: All CHSI locations will be closed on Monday, February 20th, in observance of Presidents' Day. We will reopen on Tuesday, February 21st with normal business hours.

Registration Forms

New Patient Information Form

Scan with your smartphone’s camera, or click the QR code to get started.

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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