Operators of Federally Qualified Community Health Centers (FQHCs) in NW Florida
We provide affordable health and dental care for your entire family!
For MEDICAL services, we accept:
For DENTAL services, we accept:
Download and print the appropriate medical or dental patient intake form. Follow instructions for each.
- MEDICAL Form (PDF): 7 pages. Open in Internet Explorer. Complete this form prior to your first medical visit. After you’ve completed your form, call us to schedule your first appointment at the facility of your choice on the center of this web page. We’ll instruct you on additional documents you may need to bring. Completing the form from home will save you time at the clinic.
- DENTAL Form (PDF): 7 pages. Open in Internet Explorer. Complete this form prior to your first visit for dental services to either our Panama City or Freeport facility. We need your completed form BEFORE we can make your first appointment. Fax the completed form to us or mail/deliver to the facility at which you wish to make your appointment listed in the center of this web page.
(In case of an emergency, call 9-1-1)