Wesley Health Centers Patient Information Forms

New patients can save time during their first appointment by completing the necessary forms prior to seeing your Wesley Health Centers doctor. Simply print out the appropriate form, fill in the information requested, and bring the completed form with you to your appointment.

Patient Information Form

Patient Forms for Dental Care

COVID-19 Patient Information Forms

COVID-19 Patient Dental Forms

Patient Forms for Nutritional Services for People Living with HIV/AIDS (PLWHA)

Staying Healthy Assessment Forms

The Health Resources and Services Administration (HRSA) consider JWCH Institute, Inc. / Wesley Health Centers and its providers as Public Health Services employees, providing malpractice liability protection under the Federal Tort Claims Act (FTCA). This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

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