Find the forms that you need

Patient Forms


Our front office can help you identify which forms you need to fill out.  For help or any questions, please contact our front office with the information to the left.


Medical Forms

Thank you for choosing Desert Senita Community Health Center.  Interested in completing your new patient paperwork prior to your appointment?  Please print, complete, and bring to your appointment.

For new pediatric patients under the age of 13, please also complete the forms below:


Dental Forms

For new Dental Patients, please print, complete, and bring to your appointment.


Medical Records Forms

Need to send your Medical Records from a specialist to Desert Senita?  Please fill out this form and submit to our Front Office:

Release with DSCHC Information | Spanish Version

Need to get your own Medical Records or give family members access to your records?  Please fill out this form and submit to our Front Office:

Release without DSCHC Information | Spanish Version


Ajo Office

(520) 387-5651
Feel free to give us a call if you have any questions.

Proud Partners

Desert Senita Community 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).

Desert Senita Community Health Center sites are Federal Tort Claims Act (FTCA) deemed facilities.

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