Patient Forms The following forms and corresponding instructions have been provided for your convenience. Please note that these forms may not be the appropriate forms for all patients in all circumstances. New patient? Get Started New Patient Registration No Show & Cancellation Policy Aviso a Clientes Financial Assistance Form Solicitud de Ayuda Financiera Price List Information Lista de precios Recovery Group Uninsured/ Non-Covered Assistance RecoverySAApp ACA Non-discrimination Notice Apendice A de la Parte 92 Notice of Privacy Practices Aviso de Prácticas de Privacidad de 4C Health Good Faith Estimate Estimación de buena fe Rights & Protection Against Surprise Medical Bills Derechos y protecciones frente a gastos médicos inesperados Individual Service PlanClient Signature Client Rights & Responsibilities Derechos y responsabilidades de los clientes Individual Service PlanParent/Guardian Signature Additional Resources Recursos adicionales 4C Health Discharge Outreach letter Carta de Descarga de Servicios Discount Fee Schedule Aviso de Tarifa con Descuento
