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Make An Appointment

 

•    Call ahead to make an appointment (740) 277-6043 option #1
•    Select your provider and location
•    Arrive 30 minutes early to complete necessary paperwork
•    Bring your Health Insurance Cards or proof of income
•    Copays must be collected at time of visit
•    Sliding Fee is available to those patients that qualify

IMPORTANT FORMS

CHILDREN'S FORMS
FCHC Welcome Message
FCHC Privacy Statement
CHILD History Form
Parental Consent Form
CHILD Patient Info
Appointment Policy
Authorization to Release Health Info

TEEN FORMS
FCHC Welcome Message
FCHC Privacy Statement
TEEN History Form
Parental Consent Form
TEEN Patient Info
Appointment Policy
Authorization to Release Health Info

ADULT FORMS
FCHC Welcome Message
FCHC Privacy Statement
Patient History Form
Patient Info
Gynecological History
Consent Form
Appointment Policy
Authorization to Release Health Info