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Patient Forms

Patient Resources

New Patient Packet

All new patients of Creek Valley Health Clinic need to fill out new patient information forms before their first appointment. In order to streamline the check-in process, you can print the forms here and fill them out before you come in. Along with your new patient forms, please bring in proof of income to qualify for our Healthshare Discount Program. This can be a paycheck stub, bank statement, letter from your employer, or other documentation of your household income.

If you do not have proof of income at the time of registration, you can still qualify for our Healthshare Discount Program by using a self-attestation of income for 30 days. After 30 days, we will need proof of income to secure your spot on our Sliding Scale for one year. If you have any questions about our Healthshare Discount Program or our new patient forms, please call us at 435-900-1104 and we can help you.

If you are filling out your new patient paperwork ahead of time, PLEASE make sure to fill out every form in its entirety.