LVHC Patient Forms

MEDICAL FORMS
New Patient Forms Please make sure you also print out the last page of the Notice of Privacy Practice below.	These are the forms you will need as a new patient. Please take your time to fill them out and bring them to your first visit.
Notice of Privacy Practice Note to New Patients: The Acknowledgement form at the end of this notice needs to be signed.	This notice is given to new patients. Please take your time to read it over and bring the signed Acknowledgement of Receipt page to your first visit.
Sliding Scale Discount Application	You may be eligible to receive a discounted rate for your visit. Please take your time to fill the application out and bring it to your visit with proof of income.

DENTAL FORMS
New Patient Forms (Currently being updated)	These are the forms you will need as a new patient. Please take your time to fill them out and bring them to your first visit.
New Patient Forms (spanish version) (Currently being updated)	Estas son las formas que usted necesitará como nuevo paciente. Por favor tome su tiempo para llenarlas y las trae a su primera visita.