New patients must complete forms prior to appointment. Forms can be downloaded, filled out, and brought to your first appointment at any of our locations. Registration packets are also available at any of our locations to pick up and complete. Registration appointments can be made by walking in or calling ahead to any of our locations.
For new BHA patient
For patients who have not seen their BHA provider within the last 24 months.
For patients who have registered approximately one year ago.
Re-registration is done annually
Sliding-Fee Scale Information
The Sliding-Fee Scale is determined by income and Federal Poverty Guidelines.
A patient will be informed of their Sliding-Fee Scale status after they have completed the registration process with a BHA Registration Counselor.
Where a patient falls on the Sliding-Fee Scale will determine their copays.
Patient Privacy Notice
Explains the disclosure of medical information.
BHA is committed to protect the confidentiality of medical information about our patients and use that information only to care for them properly. We share this information only in the manner described.
Patient Centered Medical Home
Describes what a patient-centered medical home is.
Gives the patient an opportunity to understand their role in their health care and their relationship with their provider.
Medical History Forms – Pediatric
Parents and/or legal guardians may use this form to fill out a pediatric patient’s medical history.
Authorization for Release of Medical Information
Download the medical record information release forms below.