Patient Forms

These forms are here for your convenience. It is highly recommended that you print and complete them prior to your first visit. If you have questions or need additional help filling these out, please plan on coming to the health center 30-45 minutes prior to your appointment so that staff can assist you.

HSA New Patient Forms, Spanish Download
HSA Sliding Fee Application, Spanish Download
HSA Cancellation Policy Agreement, Spanish Download

Our Locations

Health Service Alliance’s leadership is composed of the most experienced, innovative, and detail oriented professionals.

Montclair Community Health Center

MCHC is located near the 10 freeway on the West End of San Bernardino County. Services provided here include behavioral health, medical, radiology, and urgent care. We also have an onsite pharmacy for the convenience of our patients.

Palm Desert Community Health Center

Formerly known as Foothills Psychological Services, PDCHC is located on Cook St. south of the 10 and north of the 111, providing convenient service to Palm Desert, Rancho Mirage, Indian Wells and surrounding areas. Services provided at this location are for behavioral health.

Rancho Cucamonga Community Health Center

RCCHC is located just south of Foothill Blvd. east of Haven Ave. on Laural St. Services provided at this location are for behavioral health and medical.