Blessing Community Health Center

Patient Resources

New Patient Forms

Available in English and Español.

Download and complete these forms before your visit to save time at check-in. Each is available in English and Español — if you're ever unsure which version to use, call the clinic and our front desk team can help.

Patient Registration Form

Basic information needed to register as a new patient.

Agreement of Financial Responsibility

Outlines financial responsibilities associated with your care.

Consent for Services

Your consent to receive care at Blessing Community Health Center.

Sliding Fee Application

Application used to determine eligibility for sliding-fee discounts.

Ready to establish care with us?

Request an appointment online, call the clinic, or get directions to our San Bernardino location — whichever is easiest for you.

CallDirectionsAppointment