Patient Forms


PrimeCareHealth delivers culturally sensitive health care to tens of thousands of patients every year. Our community health centers are portals to high quality care and healthier lives for everyone. Come to us for everything from prenatal care and school physicals to behavioral health counseling and dental care.

Patient Forms

To get started, please download the patient registration form below in your preferred language. For parents/guardians of those under 18 years old, please also fill out the matching consent form for treatment. In addition to your completed form(s), bring the items below to your appointment.

  • Photo identification
  • Insurance card (if you have insurance)
  • If you do not have insurance, that’s ok, we’ll help you enroll or provide services without insurance
  • A list of medications you are currently taking
  • Immunization records
  • Discharge papers if you were recently admitted to a hospital

To make an appointment, please call 312-633-5841.