Forms and New Patient Information
Below are our common forms that we request you to complete electronically and submit to us before your first appointment to help make the registration process faster when you arrive.
We look forward to seeing you!
Welcome! New Patient Orientation Letter
Our new patient letter welcomes you and shares information about our hours of operations and all the services West County Health Centers has to offer. This is just for informational purposes, nothing to fill out or give to us. You may received another copy of this letter, once your Primary Care Physician has been selected.
Registration Packet
All patients are required to complete as a new patient and annually. Please click the link, and submit.
How Do I Authorize WCHC to Obtain My Patient Health Information?
This form allow us to request and obtain your medical records from other providers and facilities. We ask all new patients to complete this form. Please click the link, complete and submit. We will take it from there!
Sliding Scale
All patients without insurance who are requesting discounted services are required to complete the sliding scale application form below. Please click and complete the form. This form will prompt you to upload your proof of income, or you can bring proof of along to your appointment.
- Sliding Fee Scale Eligibility Criteria (in English and Spanish)
- Sliding Scale Application (English/Spanish)
Health Insurance Enrollment: Certified Enrollment Counselor Appointment Checklist
If you need to sign up for health insurance, this document will help you prepare for your meeting with a certified enrollment counselor. Please review the necessary requirements to apply for health insurance or CalFresh assistance.
Your Patient Bill of Rights & Responsibilities
Please review your rights and responsibilities as a patient: English ; Spanish
Your Privacy
West County Health Centers, Inc, follows all federal Health Insurance Portability and Accountability Act (HIPAA) requirements to make sure your medical records stay secure, private and safe.
All new patients must sign to show they received a copy of the Privacy Policy, this signature is located within our Registration Packet, link above.
Please review our medical information privacy policy, which describes how medical information about you may be used and disclosed and how you can get access to this information: English ; Spanish
Late Appointment Arrival
Please call ahead if you are running late 707.824.3391
We will try to accommodate you; however, in some circumstances we may have to reschedule your appointment.
Cancellation Policy
We would appreciate 24-hour notice if you need to cancel your appointment. To cancel you can reply no to your appointment reminder, click the check-in link, or call us (707)824-3391
Patient Portal
For information in regard to our patient portal, please visit our Patient Portal & Healow app Info page.