Online Forms
Short on time? Below you'll find a list of medical care forms you can download in English or Spanish and complete at home before your visit to WHF. We ask all patients to complete many of these forms before seeing a medical provider, so if you're a new patient and short on time, feel free to download, print and complete these forms before you drop by.
English Forms
BCEDP Application English
The Breast Cancer Early Detection Program was created to allow women over 40 years old and over, with no insurance to receive the annual care they deserve by covering the cost of Pap Smears, Breast Exams and Mammograms.
BCEDP Consent English
This form is to inform you of the BCEDP program and to get your consent prior to enrolling you.
Consent for Treatment - English
Is a legal form and arbitration for to sign, giving consent for treatment.
English Registration Form
A brief form of questions needed to create an account and a chart for you.
Medical History
A packet of questions designed to collect an overview of your medical history, this will assist your provider in establishing an informed relationship with you.
MR Release Form
This form is a consent allowing WHF or your previous healthcare provider to request past medical records.
Notice of privacy
Is a legally mandated form informing you of your privacy rights.
Formas en español (Forms in Spanish)
Aplicación de BCEDP
El programa de Cada Mujer Cuenta es un programa para las mujeres 40 años y mayor para recibir el cuidado annual que se merecen. Los servicios de Papanicolau, exámen de los ceños y mammograma son gratis con este programa.
Autorización para Usar o Divulgar Información Médica
Una forma de consiento y permito de requerir su alchivo de los otros provedores de salud que usted ha visto.
Aviso de Servicios Privados
Un mandato para informar los pacientes de sus derechos de privacidad.
Consiento de BCEDP
Este consiento es para informarse de la programa antes de inscribirse en el programa.
Consiento de Tratamiento (Spanish Consent for Treatment Form)
Una forma legal y arbitración para firmar y darnos su consiento para el tratamiento.
Matrícula de Paciente (Spanish Registration Form)
Un registro para crear una cuenta y alchivo para usted.
Handy Forms