Shortgrass Community Health Center

580-688-2800

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    • Home
    • About Us
    • Services
    • Patient Info & Forms
    • Formas Españolas
    • Patient Portal
    • Patient Survey
    • Contact Us

580-688-2800

Shortgrass Community Health Center
  • Home
  • About Us
  • Services
  • Patient Info & Forms
  • Formas Españolas
  • Patient Portal
  • Patient Survey
  • Contact Us

New Patient Forms

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.  

SCHC Release of Information (pdf)Download
2025 BH New Pt (pdf)Download
2025 Dental Adult New Pt (pdf)Download
2025 Dental Child New Pt (pdf)Download
2025 Medical New Pt (pdf)Download
2025 Psych Adult New Pt (pdf)Download
2025 Psych Child New Pt (pdf)Download

Financial Information

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)

Download

Good Faith Estimate Form (pdf)

Download

2024 SCHC's Pricing for HB1006 compliance (pdf)

Download

SCHC Application for Sliding Fee FILLABLE (pdf)

Download

Sliding Scale Discount Schedule 2025 (pdf)

Download
  • Home
  • Patient Info & Forms
  • Formas Españolas
  • Patient Portal
  • Patient Survey
  • Contact Us

Shortgrass Community Health Center

400 E Sycamore ST. HOLLIS, OK 73550 & 101 S. Hudson, Altus, OK 73521

580-688-2800

Copyright © 2024 Shortgrass Community Health Center - All Rights Reserved.

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