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Intake Forms for Primary Care Patients

Patient - Clinic Agreement
Primary Care Forms
Pediatric Primary Care Forms
Women's Health Form
Newborn Visit Questionnaire
Annual Medicare Wellness Forms

Intake Forms for Behavioral Health Clients

Adolescent Forms
Behavioral Health/Psychiatry Forms
TMS - Intake Form

Miscellaneous Forms

Consent to Release Information Form
Sliding Fee Discount Program Application
Sliding Fee Discount Program Policy/Procedure
Application for Reinstating KOKO Services
Consent for Non-Parent to Bring Minor Child to Appointment

All PCP adult forms must be submitted at least 48 hours before the patient's initial appointment. Failure to do so may result in rescheduling.

Annual Medicare Wellness Forms require at least 45 min to complete, check-in time will be 45 min prior to the scheduled appointment. Failure to arrive at check-in time may result in rescheduling.

At KOKO, we promise to serve everyone regardless of financial circumstances and not deny services based on race, color, sex, national origin, age, disability, religion, sexual orientation, or gender identity.