Patient Registration
To reduce waiting time, please click the link below to download the registration form. Next, print the form, then fill out all of the information, and bring the printed form with you on your first visit to the nearest DHC healthcare facility to your location.
Download (printable document)
Patient Registration form [english version]
Patient Registration form [spanish version]
Documents Needed
Photo Identification
Insurance card(s), including Medicaid & Medicare
All current medications
Immunization records
Proof of income & address
Copayment or sliding fee costs
Hospital admission paperwork for emergency room visits within the last 30 days