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661-874-4050
Lancaster
*CLICK ON EACH BULLETIN TO VEIW/DOWNLOAD SPECIFIC FORMS*
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2024 English Patient Registration (pdf)
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2024 Spanish Patient Registration (pdf)
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Sliding Fee Application (pdf)
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Aplicacion para escala de descuento (pdf)
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Sliding Fee Medical Chart
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Sliding Fee Behavior Health Chart
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Sliding Fee Ryan White Chart
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Sliding Fee Specialty Department Chart
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Affidavit of Income
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No Income of Affidavit
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Affidavit of Income (Spanish)
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No Income of Income (Spanish)
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Support Affidavit
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