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Forms & Policies Cover
For Patients
Forms & Policies

Please use this page to conveniently download our Forms and review our Policies.

Forms

New Patient Registration (Adult)  - This registration packet must be completed before your first visit with any Horizon Health Services provider. 

New Patient Registration (Child 0-18) - This registration packet must be completed before your first visit with any Horizon Health Services provider. 

Adult Dental Health History Form - This form is to be completed before your first visit with our dentist or dental hygienist. It will also be updated annually. 

Child Dental Health History Form - This form is to be completed before your child's first visit with out dentist or dental hygienist. It will also be updated annually.

Adult Cancer Screening Form - This form is to be completed before your first visit with our medical provider and will be updated quarterly to ensure quality care is provided.

Sliding Fee Discount Program Application - This application must be completed and returned for consideration for the Sliding Fee Discount Program.

 

Policies

 Patient Privacy Information

 No Show Policy

Notice of Privacy Practices

Patient Rights and Responsibilities

 

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