Patient Forms

When possible, we ask that you print and complete the below new patient registration forms and bring them to your first appointment. Registration forms are available in several languages, and we also offer translation services if you do not see your preferred language listed below.

Along with your completed registration forms, please also bring:

  • Photo ID if available
  • Documents to determine sliding scale enrollment
  • Insurance card if available
  • Current medication list
  • Current pharmacy name and location if available
  • Previous medical history if available

If you would prefer to have your medical records sent to the Health Center ahead of your scheduled appointment, please have them faxed to the Health Center at 855-208-4527.

This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n). Lutheran Social Services of Central Ohio is a United Way agency, a member of Lutheran Services in America and a non-profit 501(c)(3) organization.
Copyright © 2016 Lutheran Social Services. All Rights Reserved.