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SLIDING FEE DISCOUNT PROGRAM APPLICATION Date Patient Name Address Phone Number Ethel Family Clinic (BFC) defines a household as all individuals residing in the same home and sharing expenses. Household
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Beforml family clinic empowers individuals by providing comprehensive medical care, mental health services, and empowering resources to help individuals take control of their health and well-being.
Individuals who have received services from beforml family clinic or are seeking services from the clinic may be required to fill out the empowering individuals form.
To fill out the empowering individuals form, individuals must provide their personal information, medical history, current health concerns, and goals for improvement.
The purpose of beforml family clinic empowering individuals is to gather important information about each individual's health and wellness journey to provide tailored care and support.
Information such as personal details, medical history, current health concerns, goals for improvement, and any specific needs or preferences must be reported on the empowering individuals form.
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