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Thomas Chittenden Health CenterThomas Chittenden Health Center
Monday - Friday 8am - 5pmSaturday a.m. for acute visits802-878-8131Contact us586 Oak Hill RoadWilliston, VT 05495
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    • Mission and History
    • Core Values
    • Inclusivity
    • Independent Practice
    • Employment Opportunities
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  • Services
    • Our Practice Model
    • Care Coordination
    • Medical Services
    • Laboratory and Imaging Services
    • Mental Health and Social Services
    • Nutrition and Diabetes Education Services
  • Providers
  • Patient Info
    • Apointment Info
    • Forms
    • Patient Education
    • Billing Information and Online Payment
  • Become a Patient
  • Patient Portal

Patient Information

Keeping you healthy and happy!

Online Forms

Complete these forms on our secure online platform.

Online form links

  • Records Release Form
  • Consent to Release Protected Health Information to Family and Friends
  • Adult Health History Form
  • Child Health History Form
  • Workers Compensation Authorization Form
  • Auto Insurance Authorization Form
  • TeleHealth Informed Consent Form
  • New Patient Packet  – Includes the Registration and Consent Form, the Records Release Form, the Payment Policy and the Privacy Policy.

Forms to Download

These PDF forms are available to fill out and print.

Downloadable PDF forms

  • Records Release Form
  • Consent to Release Protected Health Information to Family and Friends
  • Adult Health History Form
  • Child Health History Form
  • Telehealth Informed consent
  • Workers Compensation Authorization Form
  • Auto Insurance Authorization Form

Policies


  • Payment Policy
  • Privacy Policy
  • What is covered at a Physical Exam


New to TCHC?

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Current Patient?

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© Thomas Chittenden Health Center • Website Privacy Policy • Employment Opportunities

  • Mon–Fri 8am – 5pm
    Sat/Sun acute visits
  • (802) 878-8131
    Contact us
  • 586 Oak Hill Rd.,
    Williston, VT 05495
  • Online Bill Payment

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Wi-fi available on site
*If this is a medical or mental health emergency, please call 911*