Become Our Patient

Welcome to CHDC - Community Health & Dental Care! Here at CHDC, we offer affordable healthcare for the whole family! With four convenient locations throughout the Tri-County area, we want to ensure that you can access the care you want, when you need it. We offer a wide range of services, including medical, dental, vision, physical therapy, podiatry, OB/GYN, behavioral health, and more!

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

Step 3: Apply for Healthcare Discount*

Step 4: Once your forms are completed, please contact us at 610-326-9460 to speak with our Pre-Registration team.

*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:

New Medical Patients

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 Patient Registration

Required for all new Medical patients

English | Spanish

New 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.

New Dental Patients

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 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: Fill out the Healthcare Discount Application.

Step 2: If you don't have any income or paystubs, fill out the Self-Declaration of Income & Housing Form.

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

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!