Need to schedule an appointment? Contact us at 937.599.1411.
Forms and Links
School Based Forms (Students or school staff who plan to visit one of our school-based health centers should complete the registration form listed below. )
Web Based Forms (New patients should complete the New Patient Information Form, or download the New Patient Printable Packet)
Downloadable Forms
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- Patient Bill of Rights
- Notice of Privacy Rights
- Sliding Fee information
- Sliding Fee Application
- Standard Authorization – Release of Information
- Standard Authorization – Release of Information (Spanish)
- Standard Authorization – Release of Information (SBHC)
- Standard Authorization – Release of Information (SBHC – Spanish)
- Newborn Patient Information
- Advanced Directives Packet
In the News
- House Testimony on HB 96: Tara Bair (CHWP CEO and OACHC’s Board Chair) testifies with others before the Ohio House Medicaid Committee regarding the 340B provisions in the state operating budget. Watch the testimony starting at 42:25. — The Ohio Channel (March 5, 2025)
- Community Health & Wellness Partners Welcome Katie Miller CNP (December 2023)
- CHWP opens Riverside Community Health Center (October 2023)
- Indian Lake’s new Community Health Center successful update given at Board of Education meeting (June 2023)
- CHWP opens third school-based health clinicPeak of Ohio (February 2023)
- CHWP School-Based Center now open at Indian Lake Schools — Peak of Ohio (Januaary 2023)
- Local school district to build health and wellness center — Dayton Business Journal (October 2022)
- CHWP to open school-based health care center at Riverside Schools — Bellefontaine Examiner (October 2022)
- Riverside adds community health center — Peak of Ohio (October 2022)
- CHWP CEO, Tara Bair, Named to Ohio 500 Most Influential Leaders List — Smart Business (September 2022)
- CHWP Earns National Community Health Quality Recognition — Peak of Ohio (September 2022)
- CHWP CEO Tara Bair Honored with 2022 Smart 50 Award — Smart Business News (July 2022)
- Urbana Community Health Center to Have Grand Opening — Springfield News-Sun (August 2022)
- Photos: New Urbana Community Health Center — Springfield News-Sun (August 2022)
- Ribbon Cut on New Health Center — Urbana Daily Citizen (August 2022)
- Urbana Community Health Center to Have Grand Opening — Yahoo Finance (August 2022)
- CHWP Celebrates National Health Care Week – Bellefontaine Examiner (August 2022)
- CHWP Clinic to Open in Urbana with Fees Based on Economic Situations – Springfield News-Sun (July 2022)
- CHWP welcomes Dr. Steven R. Toney – Urbana Daily Citizen (June 2022)
- CHWP Welcomes Dr. Steven R. Toney – 6ParkNews (June 2022)
- CHWP expands services to Champaign County with new Urbana location – Bellefontaine Examiner(June 2022)
- Community Health & Wellness Partners Expands Services to Champaign County – OACHC (June 2022)
- CHWP adding Urbana location – Urbana Daily Citizen (June 2022)
- Community Health & Wellness Partners Expands Services to Champaign County – Peak of Ohio (June 2022)
- Benjamin Logan Schools opens school-based health center for students, staff and parents – WHIO (March 2022)
- Funds for School-Based Health Care Coming to Indian Lake and Riverside Schools – Peak of Ohio (March 2022)
- Governor awards $25.9M in School-Based Health Center funds – Bellefontaine Examiner (March 2022)
- Benjamin Logan Elementary Holds Ribbon Cutting Ceremony for Health Clinic – Peak of Ohio (February 2022)
- Ben Logan’s new school-based health care center celebrated – Bellefontaine Examiner (February 2022)
- Stars in Business recognized – Bellefontaine Examiner (November 2021)
- STARS in Business: Peak of Ohio (November 2021)
- Peak of Ohio (November 2021)
- Peak of Ohio (October 2021)
- Bellefontaine Examiner (September 2021)
- ITAG — Peak of Ohio (September 2021)
- HRSA Award — Peak of Ohio (September 2021)
- Smart Business Columbus (August 2021
- Smart Business Magazine (July 2021)
- Springfield News Sun (June 2021)
- Peak of Ohio (June 2021)
- Dayton Business Journal (February 2021)
- Springfield News Sun (January 2021)
- MSNBC (March 2020)
- Ohio Business Magazine (January 2020)
- Peak of Ohio (December 2019)
- WOSU (June 2019)
- The Columbus Dispatch (May 2019)
