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Complete all pre-visit forms before your scheduled appointment.

Forms

 

 

 

  • Registration Form Update 2020 – ENGLISH
  • Registration Form Update 2020 – SPANISH
  • SLIDING FEE ENGLISH (English)
  • SLIDING FEE SPANISH(Spanish)
  • Sliding Fee Packages
  • Welcome Letter (Spanish)
  • Welcome Letter (English)
  • UCONN Student Registration form (English)
  • SBHC Consent Spanish V2
  • SBHC English Consent V2
  • English – Pt Copy of Bill of Rights, HIPPA, Attendance Policy
  • English- Pt registration form and consent
  • Spanish – Pt Copy of Bill of Rights, HIPPA, Attendance Policy
  • Spanish – Pt registration form and consent
  • Medical Records Authorization to Release Records_2022 English
  • Medical Records Authorization to Release Records_2022 Spanish

 

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Contact Us

Main Office
982 East Main Street
Bridgeport, CT 06608-2409

T: 203.696.3260
F: 203.696.3269

M/W/TH/F: 8AM–5PM
TU: 8AM–7PM


Referral Department

T: (203) 683-9029 | F: (203) 683-3600

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