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Axis Community HealthAxis Community Health
Axis Community HealthAxis Community Health
  • Home
  • Become A Patient
    • Enrollment
    • New Patient Resources
  • Patient Services
    • MyChart Patient Portal
    • Medical Clinic
      • Meet The Providers
      • Adult & Geriatric Medicine
      • Pediatrics
      • Immunization & Flu Shots
      • Reproductive Health Services
        • Prenatal Care & Obstetrics
        • Pregnancy Tests
      • Chronic Care Management
      • Clinical Nutrition
      • Colon Cancer Screenings
    • Acupuncture
    • Chiropractic
    • Dental
    • Mental Health
      • Meet The Providers
      • Counseling Services
      • Addiction Counseling
      • Community-Based Counseling
      • Axis Bridge Mental Health Urgent Care
    • WIC Nutritional Services
  • Donations
    • Donate to Axis
    • New Livermore Clinic
  • News & Events
  • About Us
    • Our Mission
    • Contact Us
    • Locations & Directions
    • Hours of Operation
    • Board of Directors
    • Leadership
    • Jobs & Volunteering
    • Notice of Privacy Policy
    • FAQ
  • Resources
    • Food Resources
    • Community Resources
    • Patient Forms
    • COVID-19
  • Newsletter Sign-Up

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RESOURCES

Medical Forms

Telehealth Consent OCHIN – English

Telehealth Consent Form – Spanish

Notice of Privacy Practices – English

Notice of Privacy Practices – Spanish

Acknowledgment of Receipt of Notice of Privacy Practice – English

Acknowledgment of Receipt of Notice of Privacy Practice – Spanish

Informed Consent for Medical Treatment – English

Informed Consent for Medical Treatment – Spanish

Dental Forms

Consent to Dental Treatment – English

Consent to Dental Treatment – Spanish

Medical and Dental History Form – English

Medical and Dental History Form – Spanish

Behavioral Health Forms

Medical Record Release – English

Medical Record Release – Spanish

PLEASE UPLOAD PATIENT MEDICAL RECORDS HERE:

OUR MISSION
The mission of Axis Community Health is to provide quality, affordable, accessible and compassionate health care services that promote the well-being of all members of the community.
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Axis Community Health receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

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