New Patient Registration

Welcome to the Petaluma Health Center.
New Patients Register Online Here, it’s fast and easy:

New Patient Registration

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

Our new patient letter welcomes you and shares information about Petaluma Health Center.

• English
• Spanish

Registration Form

All patients are required to complete. Please print, fill out and bring along to your appointment.

• English
• Spanish

How Do I Release my Medical Records to other Facilities?

This will allow us to release your medical records to other providers and facilities.

• English
• Spanish

How Do I Authorize PHC to Text Me Appointment Reminders and other Healthcare Communications?

• English
• Spanish

How Do I Authorize PHC to Obtain My Patient Health Information?

This will allow us to obtain your medical records from other providers and facilities. We ask all new patients to complete this form.  Please print, fill out and bring along to your appointment.

• English
• Spanish

Sliding Scale Schedule

• Sliding Fee Scale – English
• Sliding Fee Scale – Spanish

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.

• English
• Spanish

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.

• English
• Spanish

Rights & Responsibilities

Please review your rights and responsibilities as a patient: English Spanish

Your Privacy

Petaluma Health Center follows all federal Health Insurance Portability and Accountability Act (HIPAA) requirements to make sure your medical records stay secure, private and safe.

All new patients must sign a form to show they received a copy of the Privacy Policy:

Please review our medical information privacy policy, which describes how medical information about you may be used and disclosed and how you can get access to this information: English   Spanish

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