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Patient forms
Patient Forms

Community of Hope Patients, you can access all the necessary forms for our new tele-health services below!

The Care That You Want, When You Need It.

You are our partner in building a thriving organization that creates opportunities for low-income and homeless families in our city. We want you to have all the information you need to make informed giving decisions and to see how your generosity is put to use.

Downloadable Forms

Informed Consent Form

Release of Medical Records

Financial Responsibility Consent

Sliding Fee Scale Application

Patient Rights and Responsibilities

Controlled Substances Contract

DC Medical Orders for Scope of Treatment (MOST) - Advance Directive

Patient Portal
We have partnered with E-clinical to help our patients better access their health information!
Setting Up Healow

To get started, you’ll need your username and password. To get these, please contact the Patient Services Team at… Once you have your username and password, follow the instructions to start using Healow today!

Follow the steps below and for more support with Healow and telehealth, visit website link

Set up the healow smartphone app in four easy steps!

1

Download the healow app from App Store (iPhone) or Google Play (Android phone).

2

Search our practice by entering practice code.

Practice code
JJIIAA

3

Enter your portal username and password to login.

4

Setup your pin to securely access your health records.

Your Community of Hope Pharmacy

The Community of Hope Pharmacy is a NEW in-house pharmacy where you can have your prescriptions filled. We offer friendly service, free home delivery, and same day pick up for pharmacy items. 

MAKE AN APPOINTMENT

Schedule Your Appointment Today!