Patient Forms

Before you schedule an appointment at The Free Clinic, you will need to print out and complete all the documents in our New Patient Application Packet. (For Renewal Paperwork, Click Here.)

The New Patient Application packet includes the forms below:

  • New Patient Instructions
  • Patient Information Form
  • Medical History Form
  • Consent for Treatment
  • Patient Eligibility Application
Click on the images below for an example of our patient form questions. When you are ready, click the link above to download a packet of all forms.