Patient Forms

Lowell Community Health Center makes it easy for you to access and complete patient forms and sign up for the Patient Portal.

  1. Simply click on the appropriate form, below.
  2. Print the form, fill it out, and sign it.
  3. Return it to us 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 your request within three business days. If you have questions, please call 978.937.9700 and ask to be connected with Health Information.


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Note: This site uses Google Translate. As with any automatic translation, some of the words may not match the original meaning. If any information seems confusing or incorrect, please contact the Health Center at 978-937-9700 to speak to one of our staff.

Learn more about language access.