Patient Forms & Portal

Patient PortalMake your first visit, and every visit, go more quickly: Fill out necessary paperwork ahead of time and bringing the following items with you each time that you come to a GPW Community Health Center. Please remember to scroll down to find forms for new and existing patients.

  • Government-issued photo ID (drivers license, passport, etc.)
  • Current insurance information if applicable
  • A list of any medications that you may be taking
  • Up-to-date registration forms, provided below (Download, fill and print prior to your first visit, and any time that your address, insurance or other personal information changes)
  • Sliding scale application, for new visitors without health insurance, provided below

One you are registered as a patient, you can also use the Patient Portal to manage your medical history, appointments and prescription refills online or on your phone. Existing patients, click here to get started.  If you do not have health insurance, contact our Care Coordinators for guidance on applying to ACA Marketplace, Medicaid or Medicare. If you are unable to obtain insurance, apply for our Sliding Fee Discount Program.

Registration & Change of Information Forms New patients, please print and complete the form before your visit. Existing, please fill out and bring in a Change of Information Form any time that your information changes, such as address or phone number.

New Patient Registration Packet – English

New Patient Registration Packet – Spanish

Change of Information Form – English

Cambio de Informacion – Espanol 

HIPAA Notice -English HIPAA Notice

Spanish HIPAA Amended Notice

Cancellation & Late Arrival Policies All cancellations must be made at least 24 hours in advance. Patients that cancel without notice twice will be unable to schedule an appointment and may only be seen as a walk-in patient. If a patient arrives 10 minutes after the scheduled appointment time, the patient will not be seen.