Forms

Online Patient Registration
Registro de pacientes en línea

If you don’t want to complete the registration form online, you can still download and print out the PDF version, located further down on this page.

Si no desea completar el formulario de registro en línea, aún puede descargar e imprimir la versión PDF, que se encuentra más abajo en esta página.

Download Patient Registration Forms

Registration Forms – PDF

Formularios de Registro – PDF

Community Outreach Form

for CHW use only

Complete Form

Alexander Valley Healthcare is an FTCA deemed facility. AVH 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). This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

Online Patient RegistrationRegistro de pacientes en línea

Download Patient Registration Forms

Community Outreach Form

Online Patient Registration
Registro de pacientes en línea