Operators of Federally Qualified Community Health Centers (FQHCs) in NW Florida
The following forms are here for your convience. Download, print and complete the following forms as instructed by your Community Health Center healthcare provider.
MEDICAL Form (PDF): 6 pages. Open in Firefox or Google Chrome.
5 pages. Complete this form prior to your first visit to our Community Health Center in either Panama City or Freeport. .
Complete this form prior to your first visit to our dental office in Panama City or Freeport, FL. Questions?
Updated Patient Health Information Form: 1 page. Complete this form when your health information needs to be updated.
Helpful brochures we make available: