New Patient Forms – Please print, fill out and return by mail (or drop off) to the location that you will be using.
Alcona Health Center’s Registration form and Financial Policies
Medical Records Release
ADULT-Health-History-Form-9.21.18
PEDIATRIC-Health-History-Form-5.17.18
Sliding Fee Application – Please print, fill out and return by mail (or drop off) to the location that you will be using.
Sliding Fee Supporting Documents
Download Sliding Fee Application 2020
Download Sliding Fee For Self-Employed Application 2020 Only use this long version of the form if you or someone in your household is self-employed.