Welcome to FHCCGLA
English Forms
COVID-19 Electronic Patient Form (English)
Upload Your ID
Advance Health Care Directive Form
General Consent for Treatment Form
Adult Patient Intake Packet
Pediatric Patient Intake Packet
Formularios en Español
Formulario de COVID-19
Subir identificación con fotografía
Directiva anticipada de atención de la salud
Consentimiento General Para Tratamiento
Paquete de Admisión Para Adultos
Paquete de Admisión Pediátrica
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This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2,933,524 with 60% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.