Careers

Notice of Privacy Statement

Patient Portal Login

First Time Visit

Summary Notice of Privacy Practices

Authorization Release Information

General Consent Form *

Patient Registration Form & Acknowledgement of Documents

Medical History Form *

Telehealth Authorization *

Sliding Fee Scale (Discount Notice)

FreeHIVTest*

Request for Payment Plan

Request for Hardship Waiver

Sliding Fee Scale Application

PelEx Health Information Exchange

Financial Policy

Self Declaration of Income*

Patient's Bill of Rights

Advance Directives

Patient Forms