Registration Forms
Please complete the Patient Registration, Health History and Authorization for Medical Information Exchange forms. If you need Behavioral Health services, please be sure to complete the Behavioral Health Acknowledgement.
We also need physical copies of your photo ID and all insurance card(s). Use the forms below to upload them electronically.
1. Patient Registration Form
Required for all patients
2. Adult Health History Form
Required for all adult patients
3. Pediatric Health History Form
Required for all patients 18 and under
4. Authorization for Medical Information Exchange
Required for all patients
5. Behavioral Health Acknowledgement
Only required for those needing Behavioral Health Services
6. Photo ID Upload Form
We need a physical copy of your Photo ID. If you are unable to upload your ID and insurance card electronically using this link, please bring them to any UCHC location to be scanned. A chart cannot be created without scanned copies of these cards.
7. Insurance Card(s) Upload Form
We need physical copies of all your insurance cards.If you are unable to upload your ID and insurance card electronically using this link, please bring them to any UCHC location to be scanned. A chart cannot be created without scanned copies of these cards.
8. Miscellaneous Upload Form
Have other paperwork you need to send us? Use this form
9. Parental Preauthorization for Medical Care to Children
For families who are ongoing patients of UCHC, it may be more convenient to have prior authorization for medical care delivered to minors without a parent having to be present during treatment.