New Patient Registration Forms
Thank you for your interest in becoming a patient at Coal Country Community Health Center. When visiting, we ask that you:
- Arrive 15 minutes before your appointment for registration
- Bring your insurance card, copay, photo ID, and medication list
- Your medical record provides a continuous history of your medical care. Your doctor may request that you transfer your previous medical record to Coal Country. The information in your record is confidential and cannot be released without your consent.
- To be prepared for your visit, you are welcome to download and fill out the New Patient Registration Form. We will need these completed at your first visit to establish care.