top of page

(423)442-2622

Home
About us
Services
Staff
Locations
Patient Information
Careers
Pay Your Bill
More

Use tab to navigate through the menu items.

Patient Information

Información del paciente

Patient Registration Form

Privacy Information

Good Faith Estimate

Patient Authorization

Sliding Fee Application

Consent to Release Information

Patient Portal User Guide

Rights & Responsibilities

Treatment of a Minor

Sports Physical Packet

formulario de registro de pacientes

información de privacidad

Autorizacion del Paciente

Solicitud de Escala Variable de Honorarios

portal del paciente

derechos y responsabilidades

Con Respecto al Tratamiento de un Niño:

Formato de Consentimiento

Consentimiento para Divulgar Información

© 2023 This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. Chota Community Health Services complies with applicable Federal Civil Rights Laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Chota Community Health Services no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo Click here for more information.

This practice serves all patients regardless of inability to pay. Discounts for essential services are offered based on family size and income.

Esta práctica sirve a todos los pacientes, independientemente de la incapacidad de pago. Descuentos para los servicios esenciales son ofrecidos dependiendo de tamaño de la familia y de los ingresos.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Health Center Cluster grant, grant number H80CS06461, award amount $1,981,506, 82% financed with nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

bottom of page