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Patient Registration

Welcome to Coal Country Community Health Center! We are so happy that you have chosen us to partner with you in your care. Below you will find our new patient paperwork, as well as information about what to know before your first appointment.

If you have any questions about your first appointment or any of our paperwork, please give us a call and we’d be happy to help.

When preparing for your first visit, we ask that you:

  • Arrive 15 minutes before your appointment for registration.
  • Bring your insurance card, copay, photo ID, and medication list.
  • Transfer your previous medical record to Coal Country Community Health Center if needed. The information in your record is confidential and cannot be released without your consent.
  • Download and fill out the New Patient Registration Forms. We will need these completed at your first visit to establish care.

New Patient Registration Forms