Wellness
FORMS
Become a New Patient
To schedule an initial appointment, please complete Registration Forms.
Adults are ages 18+ | Pediatrics are ages 17 and under
You can submit forms online or request to have a packet mailed to you.
If you have a packet mailed, you will need to return your paperwork by fax (530) 672-1507, mail, or hand deliver.
5168 Honpie Road
Third Floor
Placerville, CA 95667
Questions?
Stop by the third floor of the Health & Wellness Center or call | (530) 387-8037
California Voter Registration
To register to vote in person come into one of our offices and a trained staff member will give you a California Voter Registration form.
Please Bring
• Diver license or ID card. If you do not have either, you can provide the last four of your social security number
• Mailing address
To register to vote online, please click HERE.