Registration Forms - Community Health Systems, Inc.

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Holiday Notice: All CHSI locations will be closed on Thursday, July 4th, 2024, for Independence Day. We will reopen on Friday, July 5th, 2024, with normal business hours.

NOTICE: All CHSI locations will have modified hours and close early on March 15th, 2024. Please contact your nearest CHSI Health Center for their specific closing times.

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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