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
English / Fillable English / Fillable SpanishConsent for Teledentistry Visit –
Patient Forms for Nutritional Services for People Living with HIV/AIDS (PLWHA)
Fillable English / Fillable SpanishNutritional Services Enrollment Form –
COVID-19 Patient Information Forms
COVID-19 Patient Dental Forms
Page 1 English – Page 2 English / Page 1 Spanish – Page 2 SpanishDental Screening Form