{"id":2490,"date":"2026-03-31T01:14:34","date_gmt":"2026-03-31T05:14:34","guid":{"rendered":"https:\/\/betances.org\/staging\/?page_id=2490"},"modified":"2026-04-28T03:54:36","modified_gmt":"2026-04-28T07:54:36","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/betances.org\/staging\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"<div class=\"et_pb_section_0 et_pb_section et_section_regular et_flex_section\">\n<div class=\"et_pb_row_0 et_pb_row et_block_row\">\n<div class=\"et_pb_column_0 et_pb_column et_pb_column_4_4 et-last-child et_block_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_text_0 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module\"><div class=\"et_pb_text_inner\"><h2><strong>Patient Forms<\/strong><\/h2>\n<\/div><\/div>\n\n<div class=\"et_pb_divider_0 et_pb_divider et_pb_space et_pb_divider_position_top et_pb_module\"><div class=\"et_pb_divider_internal\"><\/div><\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_row_1 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_1 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_image_0 et_pb_image et_pb_module et_flex_module\"><span class=\"et_pb_image_wrap\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/betances.org\/staging\/wp-content\/uploads\/2026\/01\/cropped-bhc_logo2-150x150.webp\" title=\"cropped-bhc_logo2.webp\" width=\"150\" height=\"150\" srcset=\"https:\/\/betances.org\/staging\/wp-content\/uploads\/2026\/01\/cropped-bhc_logo2-150x150.webp 150w\" class=\"wp-image-2110\" \/><\/span><\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_row_2 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_2 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_12_24 et_flex_column_12_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_image_1 et_pb_image et_pb_module et_flex_module\"><span class=\"et_pb_image_wrap\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/betances.org\/staging\/wp-content\/uploads\/2026\/04\/Forms.jpg\" title=\"Forms\" width=\"225\" height=\"225\" srcset=\"https:\/\/betances.org\/staging\/wp-content\/uploads\/2026\/04\/Forms.jpg 225w, https:\/\/betances.org\/staging\/wp-content\/uploads\/2026\/04\/Forms-150x150.jpg 150w\" sizes=\"(max-width: 225px) 100vw, 225px\" class=\"wp-image-2829\" \/><\/span><\/div>\n<\/div>\n\n<div class=\"et_pb_column_3 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_12_24 et_flex_column_12_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_1 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p class=\"\"><strong>Patient Handbook<\/strong><\/p>\n<ul data-rte-list=\"default\">\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/PatientHandbook_Eng.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Spanish-Patient-Booklet-Re-formatted-March-2024.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Chinese-Patient-Booklet-Re-formatted-March-2024-2-9p2t.pdf\" target=\"_blank\" rel=\"noopener\">Chinese<\/a><\/p>\n<\/li>\n<\/ul>\n<p class=\"\"><a href=\"https:\/\/mycw41.eclinicalweb.com\/portal4540\/jsp\/100mp\/login_otp.jsp\" target=\"_blank\" rel=\"noopener\"><strong>Patient Portal<\/strong><\/a><\/p>\n<p class=\"\"><strong>Patient\u2019s Bill of Rights<\/strong><\/p>\n<ul data-rte-list=\"default\">\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Patient-Privacy-Practice-English-rhr6.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Patient-Privacy-Practice-Spanish.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Patients-Bill-of-Rights-Cc.pdf\" target=\"_blank\" rel=\"noopener\">Chinese<\/a><\/p>\n<\/li>\n<\/ul>\n<p class=\"\"><strong>Patient PCMH Agreement<\/strong><\/p>\n<ul data-rte-list=\"default\">\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Patient-PCMH-Agreement-2017-ENGLISH.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Patient-PCMH-Agreement-2017-Span.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Patient-PCMH-agreement-chinese.pdf\" target=\"_blank\" rel=\"noopener\">Chinese<\/a><\/p>\n<\/li>\n<\/ul>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/12032-Betances-English-Privacy-Notice-2016.pdf\" target=\"_blank\" rel=\"noopener\"><strong>Privacy Policy<\/strong><\/a><\/p>\n<p class=\"\"><strong>Registration Form<\/strong><\/p>\n<ul data-rte-list=\"default\">\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Registration-Packet_English_7-2024-Update-combined-rev731.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Registration-Packet_Spanish_7-2024-Update-combined-rev731.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Registration-Form-2019-chinese.pdf\" target=\"_blank\" rel=\"noopener\">Chinese<\/a><\/p>\n<\/li>\n<\/ul>\n<p class=\"\"><strong>Betances New Patient Satisfaction Survey<\/strong><\/p>\n<ul data-rte-list=\"default\">\n<li>\n<p class=\"\"><a href=\"https:\/\/www.surveymonkey.com\/r\/SQ7KY8X\" target=\"_blank\" rel=\"noopener\">English<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/www.surveymonkey.com\/r\/9HQXN7J\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/www.surveymonkey.com\/r\/2DQ98KK\" target=\"\">Chinese<\/a><\/p>\n<\/li>\n<\/ul>\n<p class=\"\"><strong>Betances All Patient Satisfaction Survey<\/strong><\/p>\n<ul data-rte-list=\"default\">\n<li>\n<p class=\"\"><a href=\"https:\/\/www.surveymonkey.com\/r\/SQ7KY8X\" target=\"_blank\" rel=\"noopener\">English<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/www.surveymonkey.com\/r\/9HQXN7J\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/www.surveymonkey.com\/r\/2DQ98KK\" target=\"\">Chinese<\/a><\/p>\n<\/li>\n<\/ul>\n<p class=\"\"><strong>Healthix Consent Form<\/strong><\/p>\n<ul data-rte-list=\"default\">\n<li>\n<p class=\"\"><a href=\"https:\/\/static1.squarespace.com\/static\/5bda72e7f7939243a747c681\/t\/5be9fc574fa51a2b58ac5897\/1542061143356\/Consent+Form+for+Healthix+Participants+without+Emergency+Services_Provider+Only+%28Betances+Health+Center%29.pdf\" target=\"_blank\" rel=\"noopener\">English<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Consent-Form-for-Healthix-Participants-without-Emergency-Services_Provider-Only_20140725_Spanish.pdf\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/p>\n<\/li>\n<li>\n<p class=\"\"><a href=\"https:\/\/betances.org\/staging\/s\/Healthix_Consent-sep-2020_Simplified-Chinese.pdf\" target=\"_blank\" rel=\"noopener\">Chinese<\/a><\/p>\n<\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_row_3 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_4 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_divider_1 et_pb_divider et_pb_space et_pb_divider_position_top et_pb_module\"><div class=\"et_pb_divider_internal\"><\/div><\/div>\n\n<ul class=\"et_pb_social_media_follow_0 et_pb_social_media_follow et_pb_bg_layout_light et_pb_module et_flex_module\">\n<li class=\"et_pb_social_media_follow_network_0 et_pb_social_media_follow_network et_pb_social_icon et_pb_social_network_link et-social-facebook et_pb_module et_flex_module\"><a href=\"https:\/\/www.facebook.com\/iambetances\" class=\"icon\" title=\"Follow on Facebook\" target=\"_self\" rel=\"noopener\"><span class=\"et_pb_social_media_follow_network_name\">Follow<\/span><\/a><\/li>\n\n<li class=\"et_pb_social_media_follow_network_1 et_pb_social_media_follow_network et_pb_social_icon et_pb_social_network_link et-social-instagram et_pb_module et_flex_module\"><a href=\"http:\/\/instagram.com\/betanceshealthcenter\" class=\"icon\" title=\"Follow on Instagram\" target=\"_self\" rel=\"noopener\"><span class=\"et_pb_social_media_follow_network_name\">Follow<\/span><\/a><\/li>\n\n<li class=\"et_pb_social_media_follow_network_2 et_pb_social_media_follow_network et_pb_social_icon et_pb_social_network_link et-social-youtube et_pb_module et_flex_module\"><a href=\"https:\/\/www.youtube.com\/channel\/UCAmCfEEnhDnBvKWTulxswtg\" class=\"icon\" title=\"Follow on Youtube\" target=\"_self\" rel=\"noopener\"><span class=\"et_pb_social_media_follow_network_name\">Follow<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Patient form you might need.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2490","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/betances.org\/staging\/wp-json\/wp\/v2\/pages\/2490","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/betances.org\/staging\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/betances.org\/staging\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/betances.org\/staging\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/betances.org\/staging\/wp-json\/wp\/v2\/comments?post=2490"}],"version-history":[{"count":4,"href":"https:\/\/betances.org\/staging\/wp-json\/wp\/v2\/pages\/2490\/revisions"}],"predecessor-version":[{"id":2830,"href":"https:\/\/betances.org\/staging\/wp-json\/wp\/v2\/pages\/2490\/revisions\/2830"}],"wp:attachment":[{"href":"https:\/\/betances.org\/staging\/wp-json\/wp\/v2\/media?parent=2490"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}