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New Patient Paperwork  and Forms


Glacier Community Health Center Privacy Practices (HIPAA)

After reading the Privacy Statement, please download the Acknowledgement form, sign it, and bring it with you to your first clinic visit.

New patients should download the forms, fill them out and bring them in to their appointment.

Notice of Privacy Practices: Adobe Acrobat || MS Word

Notice of Privacy Practices-Acknowledgement: Adobe Acrobat || MS Word

Patient Safety for Patients: Adobe Acrobat || MS Word


New patients should download the forms, fill them out and bring them in to their appointment.

Patient Social and Medical History: Adobe Acrobat || MS Word

Patient Information: Adobe Acrobat || MS Word

Appointment Agreement: Adobe Acrobat || MS Word

Authorize to Give Information: Adobe Acrobat || MS Word

Patient Partner Advisory Council

GCHC’s Patient Partner Advisory Council is made up of eleven interested patient partners who have volunteered to advise GCHC’s leadership, providers and staff through a team approach to patient-centered healthcare from a patient’s and family member’s perspective.  They meet quarterly (January/April/July/October). 

The Advisory Council works in partnership with Glacier CHC staff and providers to:

    *Strengthen communication and collaboration among patients, families, caregivers, providers and staff.

    *Provide input and feedback to leadership, providers and staff in planning and evaluating programs, policies, services, and facilities.

    *Advocate for, promote, and support the philosophy of patient-centered care.

    *Foster accountability for a healthcare environment that is safe, accessible and supportive.

    *Promote activities or initiatives which serve to increase patient, family, and staff engagement and satisfaction at Glacier CHC.

    *Facilitate and promote a positive relationship between Glacier CHC and the community.

If you have suggestions for the Advisory Council to consider, please send them in an email to  with ‘Advisory Council’ in the subject line.

Pt Adv Council
Patient Handbook
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