Become Our Patient

Take the time and explore this page to learn more about our services and locations, as well as the steps needed to become a CHDC patient! We offer affordable healthcare for the whole family. With convenient locations throughout the Tri-County area, we want to ensure that you can access the care you want, whenever you need it. We offer a wide range of services, including medical, dental, vision, physical therapy, podiatry, OB/GYN, behavioral health, and more.

Once you become a patient, you'll receive high-quality care in addition to connecting with our incredible team of providers and staff. CHDC offers convenient locations throughout the Tri-County area including Pottstown, Barto, and our newest office in Boyertown - Now Open!

Become a CHDC Patient in 4 Easy Steps:

Step 1: Choose to become a Medical patient or Dental patient

Step 2: Complete and sign the forms below. If you need help completing any of the required patient forms, please make an appointment with our Pre-Registration staff by calling 610-326-9460 ext. 565.

Step 3: Apply for Healthcare Discount*

Step 4: Contact us at 610-326-9460 to speak with our Pre-Registration team once your forms are completed

*All CHDC patients are encouraged to apply for the Healthcare Discount.

Regardless of insurance status, the Healthcare Discount helps to bridge the patient's financial responsibility for services. Apply today to see if you qualify for our discount! Discounts are based off family size and income.

I want to:

Become Our Medical Patient

To become a new CHDC Medical patient, please complete the following paperwork. Once your forms are completed, please contact us at 610-326-9460 to speak with our Pre-Registration team.

New Medical Patient Registration

Required for all new Medical patients

English Spanish

New Medical Patient Health History

Required for all new Medical patients

English | Spanish

HIPAA Release of Medical Information - Transfer In

Required to transfer records in to CHDC

English | Spanish

Once your forms are completed, please contact us at 610-326-9460 to speak with our Pre-Registration team.

Become Our Dental Patient

To become a new CHDC Dental patient, please complete the following paperwork. Once your forms are completed, please contact us at 610-326-9460 to speak with our Pre-Registration team.

New Dental Patient Registration

Required for all new Dental patients

English | Spanish

New Patient Dental Health History

Required for all new Dental patients

English Spanish

Once your forms are completed, please contact us at 610-326-9460 to speak with our Pre-Registration team.

Apply for a Healthcare Discount

ALL new patients should apply for the Healthcare Discount. Those who qualify can receive medical, dental, and dispensary services at a lower cost, based on their family size and income. Patients with or without insurance are able to apply for a healthcare discount.

Step 1: Download and fill out the Healthcare Discount Application. If you need help completing any of the required patient forms, please make an appointment with our Pre-Registration staff by calling 610-326-9460 ext. 565.

Step 2: Fill out the Self-Declaration of Income & Housing Form if you do not have any income or paystubs

Step 3: If you are self-employed, fill out the Self-Employment Form

Step 4: Please attach the information below as proof of income (if applicable):

  • Two current pay stubs and/or
  • A copy of your current year tax return and/or
  • Last two bank statements
  • If you are receiving Social Security, Disability or Pension benefits, you will be required to submit a statement from those agencies verifying the amount of benefit being received

Step 4: When you have completed the Healthcare Discount and/or Self-Declaration and/or your Self-Employment form and have proof of income, please bring them with you to your appointment or call 610-326-9460 to speak with a member of our Patient Services team.

Healthcare Discount Application

ALL new patients fill out this form

English | Spanish

Self-Declaration of Income & Housing Form

ONLY fill out this form if you have no other way to document your income and/or housing and/or have no income

English | Spanish

Self-Employment Form

ONLY use this form if you are self-employed

English | Spanish

Healthcare Discount Information

General information and frequently asked questions

English | Spanish

2024 Sliding Fee Schedule

Use this chart to see how much of a healthcare discount you may be eligible for

English | Spanish

Updated: 07/01/2024

Learn More

Additional forms and patient resources below.

Additional Forms

View our CHDC Patient Forms, available in English and Spanish

Patient FAQ

Visit our Patient FAQ page to find answers to common questions. 

Our Services

Want to learn more about the services we offer at CHDC? Visit Our Services page to see everything we offer.

Free Transportation

Need help getting to your appointment? Free transportation services available with shuttle stops in Pottstown, Spring City, Boyertown, and more.

Meet Our Providers

Meet our friendly team of CHDC providers today!

CHDC Locations

Convenient locations in Pottstown, Barto, and coming soon to Boyertown!