At your first visit, you will be asked to complete this form. If you are able to, you can save time by printing and completing this form before you arrive.
Discounted Payment Plan
For patients who are interested in applying for our Sliding Fee discount program. Learn more here.
Medical Records
For patients who would like to authorize the release of their medical records to a third party or individual.
Patient Complaint Form
For patients (or their representatives) who would like to document a patient concern regarding the health care or treatment that was received or not received.
Patient Grievance Form
For patients (or their representatives) who would like to report a patient concern that has not yet been resolved by present staff or requires further action for resolution.
Be an informed health care consumer. When you know our policies, you can make the most of your appointments and more effectively manage your health care.
Total Health Care, Incorporated (THC) is a Federally Qualified Health Center. THC is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Service employee under 42 U.S.C. 233 (h).
Total Health Care participates in the federal 340B(a)(4) pharmacy program under the Public Health Service Act.
Total Health Care is a FTCA deemed facility
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Division Health Center Closing
August 9, 2024
Total Health Care’s Division Health Center will be closed at 12 noon. All patients will be contacted to be seen at another site or appointment rescheduled.
Please contact us at (410) 383-8300 for any questions.