Our new patient letter welcomes you and shares information about Petaluma Health Center. Below are forms that you can print and complete before your first appointment to help make the registration process faster when you arrive, or we’ll give you blank copies of these forms to fill out in the waiting room. We look forward to seeing you!
Welcome! New Patient Letter
All patients are required to complete. Please print, fill out and bring along to your appointment.
Authorization for Release of Patient Health Information
This will allow us to collect your medical records from other providers and facilities. All patients are required to complete. Please print, fill out and bring along to your appointment.
Sliding Scale Form
All patients without insurance who are requesting discounted services are required to complete the sliding scale application form below. Please print, fill out and bring along to your appointment.
Health Insurance Enrollment: Certified Enrollment Counselor Appointment Checklist
If you need to sign up for health insurance, this document will help you prepare for your meeting with a certified enrollment counselor. Please review the necessary requirements to apply for health insurance or CalFresh assistance.
Late Appointment Arrival: Please call ahead if you are running late (707) 559-7500.
We will try to accommodate you; however in some circumstances we may have to reschedule your appointment. Cancellation Policy: We would appreciate 24-hour notice if you need to cancel your appointment. Call (707)559-7500