Before Your Appointment

Family and Clinic Services Forms Page

Client Forms


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Ada or Boise Co: 208-327-7400 |
Valley Co: 208-634-7194
Elmore Co: 208-587-4407

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We are looking forward to your visit to Family & Clinic Services at Central Distirct Health. Please fill out the client information forms found below on this page prior to your visit. If you would like to fill out paper forms in our office, we ask that you please arrive 15 minutes prior to your appointment time. Clients will be asked to complete these forms each year.

The forms are mobile-friendly and can also be filled out from a desktop computer.

IMPORTANT: You must have a valid email account that you can access. Once you submit your completed forms, you will receive an email to the email account you shared. You will need to open this email and follow the step to complete the form submittal process. If you do not complete this step, CDH will not receive your forms.


FORMS TO COMPLETE BEFORE YOUR APPOINTMENT

Client Information Forms (English)

The following forms are included as part of the packet of fillable forms, but are listed separately for clients who may wish to access them outside of the fillable forms.

Forms in Spanish Coming Soon!


IMPORTANT: To submit these forms electronically, you must have a valid email account that you can access.Once you submit your completed forms, you will receive an email to the email account you shared. You will need to open this email and follow the step to complete the form submittal process. If you do not complete this step, CDH will not receive your forms.


HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)


Your privacy is important to the Central District Health. We follow the regulations of HIPAA—the Health Insurance Portability and Accountability Act. You will be asked if you have read and understand the following document.
HIPAA – English Version

Su privacidad es muy importante para la Salud del Distrito Central. Nosotros seguimos las reglas de HIPAA—Notificación de Practicas Privadas. Se le preguntara si usted ha leído y entendido el documento.
HIPAA – Versión Española


HEALTH RECORDS REQUEST


Central District Health is only able to provide health records, including for immunizations, of clients who have been seen in our clinic. If services were provided at a different clinic, please contact that clinic to request your health records.

If you have been a client of Central District Health and wish to request records, the Release of Information Form must be completed and returned to Family & Clinic Services at Central District Health. The form is mobile friendly and can also be filled out from a desktop computer. You must have a valid email account that you can access. IMPORTANT: Once you submit your completed form, you will receive an email to the email account you shared. You will need to open this email and follow the step to complete the form submittal process. If you do not complete this step, CDH will not receive your request form.

Submit a Health Records Request
Note: Central District Health is only able to provide health records, including for immunizations, of clients who have been seen in our clinic. If services were provided at a different clinic, please contact that clinic to request your health records.