Forms & Policies for Medical Services

HIPPA

Coming Soon!

Enrollment Forms

New Patient Enrollment Packet June 2015

New Patient Packet-Spanish

ACA Privacy Statement

PHP application 2014 new For Assistance with move in costs (Application fee, security deposit, utility deposit, 1st month’s rent)

STRMU application 2014 new  Application for Emergency Financial Assistance (rent, mortgage, utilities)

PHP utility deposit refund agreement

Positive Impact Health Centers-STRMU-App-Translated-to-ES-US-PDF

 

 

Additional Related Services

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