Lowell Community Health Center makes it easy for you to access and complete patient forms. Start by clicking on the form you need below. For many of our forms, we are now offering an easier, secure system that allows you to submit  electronically. No PDFs to download and print! If you need immediate attention, such as for prescription refills, please call 978-322-8680.

If you select one of our HEALTH INFORMATION Virtual Forms…

  1. After clicking the form, you will be asked to provide your name and email. This will allow you to edit and sign your form and communicate with our Health Information staff.
  2. Once the form is submitted, it will be sent directly to Health Information. You do NOT need to email a copy.

If you select one of our PDF Forms (MA Healthcare Proxy, Pediatric Assessment Forms, and COVID Vaccine Consent)

  1. Print the form, fill it out, and sign it.
  2. COVID-19 Vaccine Consent Form: Simply bring it with you when you come for your vaccine.
  3. Pediatric Forms: Return by mail to:
    Lowell Community Health Center
    ATTN: Health Information
    161 Jackson Street
    Lowell, MA 01852

    or fax to 978-221-6728. If you have Adobe, you may also be able to complete electronically and email to Health Information.

We will respond to all requests within three business days. If you have questions, please call 978-322-8680.

Health Information Virtual Forms

Records Request/Release