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]

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