Patient Forms

Do you have an appointment at the clinic, lab, or other department?

You can save time by printing and filling out these forms at home. Bring them with you to your appointment or drop them off a day or two ahead of time.

• Patient Registration Form – Required for all appointments.
• Patient Consent Form – Required for all appointments.
• Consent to Treat a Minor – To be completed by the parent/legal guardian of a patient under 18 years of age.
• Financial Assistance- Sliding Fee Scale/Discounted Fee Information and Application – No one will be denied access to services due to inability to pay.  There is a discounted/sliding fee schedule available.
• Patient Payment Plan Authorization
• Cordova Community Medical Center FAQ’s