When BCHC is closed, you can always reach an on-call BCHC provider after hours.› Learn More
We have put many of our patient forms here for your convenience. These files can be downloaded to your computer or printed direct from the website and completed. If you have questions or need help with any form, please talk with your Patient Services Representative.
New Patient Forms
There are important documents that we want to be sure our patients read and understand. Please let us know if you have any questions about these or other documents.
- Welcome to BCHC (English)
- Bienvenido a BCHC (Español)
- Patient Rights and Responsibilities (English)
- Derechos y Responsibilidades del Paciente (Español)
Berks Community Health Center is committed to protecting the privacy and confidentiality of all patient information. Click one of these links to view our Notice of Privacy Practices:
General Patient Forms
- Adult Medical History – English/Spanish
- Consent for Treatment and Receipt of Notice of Privacy Practices – English
- Consent for Treatment and Receipt of Notice of Privacy Practices – Spanish
- Permitted Contacts Form – English
- Permitted Contacts Form – Spanish
- Pharmacy Choice Acknowledgement Form – English/Spanish