Forms may be printed and completed prior to your appointment. Patients may also download and complete forms on their computer.
Completed forms may be printed and brought to your appointment or emailed to info@shortgrasschc.com.
Shortgrass Community Health Center is a Federally Qualified Health Center, which allows us to offer a sliding fee scale to those without insurance. In addition, you have the right to receive a Good Faith Estimate for hte toal expected cost of any non-emergency items or services. This includes related costs like medical tests, labwork, and prescription drugs.
Good Faith Estimate Notification (pdf)
DownloadGood Faith Estimate Form (pdf)
Download2024 SCHC's Pricing for HB1006 compliance (pdf)
DownloadSCHC Application for Sliding Fee FILLABLE (pdf)
DownloadSliding Scale Discount Schedule 2026 (pdf)
Download2026 HIPAA Notice of Privacy Practices (NPP) Form (pdf)
DownloadSCHC Release of Information (pdf)
DownloadTelehealth Consent (pdf)
DownloadShortgrass Community Health Center
400 E Sycamore ST. HOLLIS, OK 73550 & 101 S. Hudson, Altus, OK 73521