HAPPY HOLIDAYS!

We will be CLOSED Thursday, November 27th, and Friday, November 28th, for the Thanksgiving holiday!
We will resume normal hours on Monday, December 1st!

Patient Forms

To download forms and information you need, click on the links below. You have the option to either complete a form now or complete the copy provided during check-in.

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Behavioral Health and Psychiatry

PATIENT HEALTH QUESTIONNAIRE

PHQ-9

Dental

HEALTH HISTORY AND CONSENT FORMS

Health History and Consent Form (English)
Health History and Consent Form (Spanish)

FIRST DENTAL HOME VISIT FORM

FDH Visit Form

HIPPA CONSENT FORM

HIPPA Consent Form

Diet and Nutrition Services

DIET RECALL INTAKE FORM

Diet Recall Intake Form

Pediatric Forms

AGES & STAGES QUESTIONNAIRES (ASQ-3) 9-48 MONTHS

9 Month Questionnaire
18 Month Questionnaire
24 Month Questionnaire
36 Month Questionnaire
48 Month Questionnaire

LEAD RISK QUESTIONNAIRES

Lead Risk Questionnaire (English)
Lead Risk Questionnaire (Spanish)

MODIFIED CHECKLIST FOR AUTISM IN TOGGLERS REVISED (M-CHAT-R)

M-CHAT-R Questionnaire

TUBERCULOSIS (TB) QUESTIONNAIRE

Tuberculosis (TB) Questionnaire

Women’s Health Forms

POLICY OF ACCEPTANCE OF PATIENTS FOR OB SERVICES

Policy of Acceptance of Patients for OB Services

OBSTETRICAL HISTORY FORM

Obstetrical History Form

PRE-ECLAMPSIA RISK FACTORS FORM

Pre-Eclampsia Risk Factors Form

OBSTETRICAL ULTRASOUND INFORMED CONSENT FORM

Obstetrical Ultrasound Informed Consent Form

Patient Forms

2024-2025 Impact Report

Click to download our report.

Download

Make the Switch to the HHM Health Pharmacy

Our pharmacy offers FREE delivery, $4 generic drugs, lower out-of-pocket costs, and more.

Our Pharmacy

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