Lack of Income Declaration
Patient Complaint
PATIENT COMPLAINT PROCESS, REV 3.26.2021_Spanish
Patient Profile (English)
Personal Representative Designation Form
Summary of Privacy Notice
Acceptable Proof of Income
Patient Information Brochure (English)
Folleto de Información del Paciente (Español)
Consentimiento para Tratamiento y Autorizaciones (Español)
Spanish Absent Parent Consent for Treatment Form
Spanish Lack of Income Declaration Form
Spanish Personal Representative Designation Form
ACCEPTABLE PROOF OF INCOME _KW_Spanish
ADVANCE DIRECTIVES BROCHURE, REV 2018_Spanish
At Teche Action Clinic, we are fully committed to providing our patients with personalized, caring service. If you have any questions or need any assistance, please Contact Us.
Teche Action Clinic is an FTCA deemed organization.
