Community Health Centers of Burlington

Site Specific Contacts | 802.864.6309 Main | 802.652.1050 Dental
802.540.8253 Patient Feedback Line
WELCOME!  Bienvenue  Bienvenidos  Đón chào
أهلًا-بكم  Dobrodosli  Ã¦Â¬Â¢Ã¨Â¿ï¿½  सवागत  Soo-dhawow
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      • School-Based Dental Center Program
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Forms

Patient Bill of Rights and Responsibilities

Notice of Privacy Practices

Patient Registration Form

Dental Patient Medical History Form

School-Based Dental Center History-Pre-K through 5th Grade

School-Based Dental Center History-6th through 12th Grade

Sliding-Fee Scale Application

Consent to Disclose Health Information

CHCB Application for Employment

Advance Directive Information and Form

Patient Advisory Committee Application

 

CME Webinar Forms

Webinar 1- UTI  Acute GI Illnesses Reg-Eval-PostTest – test

Webinar 2- Avoiding the ER_Peds Issues CME Paperwork

Webinar 3- Series (ER-Geriatric) CME REG-EVAL-POSTTEST

Webinar 4- Avoiding the ER: Practical Strategies and Nurse Triage Panel

 

Translated Materials

Patient Registration Form – Arabic

Patient Registration Form – Burmese

Patient Registration Form – Nepali

Patient Registration Form – Somali

Patient Registration Form – Vietnamese

 

Dental Patient Medical History – Arabic

Dental Patient Medical History – Burmese

Dental Patient Medical History – Nepali

Dental Patient Medical History – Somali

Dental Patient Medical History – Vietnamese

 

Sliding-Fee Scale Application – Arabic

Sliding-Fee Scale Application – Burmese

Sliding-Fee Scale Application – French

Sliding-Fee Scale Application – Nepali

Sliding-Fee Scale Application – Somali

Sliding-Fee Scale Application – Spanish

Sliding-Fee Scale Application – Vietnamese

 

School-Based Dental History Pre-K through 5th Grade -Nepali

School-Based Dental History 6th through 12th Grade-Nepali

School-Based Dental History Pre-K through 5th Grade -Somali

School-Based Dental History 6th through 12th Grade-Somali

 

Patient Rights and Responsibilities brochure-Arabic

Patient Rights and Responsibilities brochure-Burmese

Patient Rights and Responsibilities brochure-Nepali

Patient Rights and Responsibilities brochure-Somali

Patient Rights and Responsibilities brochure-Vietnamese

 

Dr. Dynasaur Health Coverage info-Arabic

Dr. Dynasaur Health Coverage info-Burmese

Dr. Dynasaur Health Coverage info-Mandarin

Dr. Dynasaur Health Coverage info-Nepali

Dr. Dynasaur Health Coverage info-Somali

Dr. Dynasaur Health Coverage info-Vietnamese

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News

Patient Support Center Closed Week of 2/25

February 22, 2019

Acceptance-Commitment-Therapy (A.C.T.) Group for Depression and Anxiety

November 16, 2018

Get your flu shot today!

November 5, 2018

Inform

Since 1971, the Community Health Centers of Burlington has provided exceptional health care to people of all ages, backgrounds, and life circumstances. Under our umbrella of comprehensive services, community residents can access primary and preventive health care, dental services, psychiatry, and mental health and substance abuse treatment provided in a compassionate, respectful, and professional manner. Read more...

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MAIN OFFICE
Community Health Centers of Burlington
617 Riverside Ave
Burlington, VT 05401

802.864.6309 Medical
802.652.1050 Dental
802.540.8253 Patient Feedback Line

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The Community Health Centers of Burlington is a 501(c)(3) non-profit and Federally Qualified Health Center funded in part through a grant from the U.S. Department of Health & Human Services and generous community support. CHCB is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

 

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