Patient Portals
Online Bill Pay
COVID-19 Info
Latest News
Search
Find a Provider
Services
Convenient Care
Patients & Visitors
Patient Forms
Community Resources
Billing / Financial Assistance
BCMH Hospital Charge Information
Patient Portals
Get the COVID-19 Vaccine
Advanced Directives
Employee Recognition Program
Gift Of Life
Patient Relations Program
Pre-Diabetes Self Assessment
Patient Liability Estimator
About Us
Mission
Our History
Board of Trustees
Accreditation
BCMH Board Meetings
Privacy Practices
Classes & Events
Careers
Working at BCMH
Current Openings
Online Application
Contact
Find a Provider
Services
Convenient Care
Patients & Visitors
Patient Forms
Community Resources
Billing / Financial Assistance
BCMH Hospital Charge Information
Patient Portals
Get the COVID-19 Vaccine
Advanced Directives
Employee Recognition Program
Gift Of Life
Patient Relations Program
Pre-Diabetes Self Assessment
Patient Liability Estimator
About Us
Mission
Our History
Board of Trustees
Accreditation
BCMH Board Meetings
Privacy Practices
Classes & Events
Careers
Working at BCMH
Current Openings
Online Application
Contact
Patient Portals
Online Bill Pay
COVID-19 Info
Latest News
Patient Forms
Fill out forms before your visit to speed things up
Home
>
Patients & Visitors
>
Patient Forms
BCMH Authorization for the Use and Disclosure of Individually Identifiable Health Information
BCMH Rural Health Clinic Cares Sliding Fee Scale Program Flier
Cares Program Discount Sliding Fee Scale Application
Referral Form
Walk-In Clinic Patient Info
2023 Flu Vaccine Consent Form – Medicare
Join The BCMH Family!
See Openings
Learn More