Forms and Policies

Provided below are forms that may require completion prior to your visit and/or testing. Please download the appropriate form(s) as directed by clicking on the name of the form. This will help save time and may expedite the registration process. Thank you.

General Forms and Policies:
Patient Information Form
CCHC Financial Policy
Consent for Treatment of Minor Child
CCHC Authorization to Not File to Insurance

HIPAA and Non-Discrimination Forms and Notices:
Authorization to Release Health Information
Authorization to Discuss Information with Others

CCHC Notice of Privacy Practices

CCHC Non-Discrimination Notice
Acknowledgement of Receipt Notice of Privacy Practices
HIPAA Complaint Form

Specialty Forms and Instructions:
Sleep Lab Instructions
Sleep Study Questionnaire
Computed Tomography (CT Scan) Questionnaire
MRI Screening Form