Patient Forms
Here you can find forms you may need for your care at Virginia Garcia. You can download and print these forms at home.
If you need any help with these forms, reach out to your care team. We’re here to help you every step of the way.
Patient Forms for Your Visit
If you need any help with these forms, reach out to your care team. We’re here to help you every step of the way.
Forms to Become a Patient
Annual Verification Form (PDF)
English
MyChart Proxy Forms
Dental Care Forms
Annual Verification Form (PDF)
English
Income Verification & Discount Eligibility Form (PDF)
English & Spanish
Adult New Patient Packet (PDF)
English
Child New Patient Packet (PDF)
English
School-Based Health Center Forms
Annual Verification Form (PDF)
English
Annual Verification Form (PDF)
Spanish
Wellness Check-In (PDF)
Grades 6-8
Wellness Check-In (PDF)
Grades 9-12
Registro de Bienestar Personal (PDF)
Grados 6-8
Registro de Bienestar Personal (PDF)
Grados 9-12
Reproductive Health Forms
Enrollment Form (PDF)
English
Enrollment Form (PDF)
Spanish
Enrollment Form (PDF)
Russian
Enrollment Form (PDF)
Simplified Chinese
Enrollment Form (PDF)
Somali
Enrollment Form (PDF)
Vietnamese
Enrollment Form (PDF)
Marshallese
Enrollment Form (PDF)
Korean
Sliding Scale Program
Income Verification & Discount Eligibility (PDF)
English & Spanish