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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- New Patient Packet
- New Patient Packet (Spanish)
- School Based Health Center Registration Form (Printable)
- 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
- 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)
