Patient Forms

Healthy Connections, Inc. provides medical, dental, and social services to people of all ages in Arkansas. Once you have made your initial appointment at Healthy Connections, you can download, print, and complete the forms below prior to your arrival. Doing so will help speed up the new patient registration process at your first visit.

Download the forms below to complete.

HCI New Patient Registration Packet East

HCI New Patient Registration Packet West

HCI New Patient Registration Packet Spanish- General

Dental – New Patient Registration Packet – English

Dental – New Patient Registration Packet – Spanish

No Income Verification Statement

Juvederm Injectable Informed Consent Form

Botox Informed Consent Form

BioTE New Patient Package

Behavioral Health Therapy – Adult
Behavioral Health Therapy – Child
Medication Management – Adult
Medication Management – Child