New Patient Forms
Before coming to the Hope Clinic for your first appointment, please print out and complete the necessary new patient forms.
[Forms are in PDF format]
en Español
La Clinica de Esperanza Registracion
Formulario de verificación de ingresos para tarifas de pago para particulares
Notificación sobre la Ley de Confidencialidad de la Información sobre la Salud
Also, bring a copy of one of the following documents to verify your service charge rate:
- Current pay stub
- Most recent W-2 form
- Statement from employer verifying income
- Shelter letter
- Treatment program letter
- Letter from case worker
- Letter from church or other health center