Clinic Registration

Patient Clinic Registration

Once you arrive in one of our clinic check-in areas, a member of our staff will speak with you and:

Ask to see a valid form of photo identification and insurance card.

Verify your contact information.

Make sure you have reviewed and signed the necessary paperwork.

Collect your insurance co-payment or deductible, if required.

Drivers license, passport, military ID or other valid photo identification (federally issued ID).

Current medical insurance information, including insurance cards, pre-certification, and other documentation required by your insurer.

All prescriptions and over-the-counter medications you are currently taking, including patches, vitamins or herbal supplements.

List of any allergies, especially to medications and food and/or other substances.

Community HealthCare System

785-889-4241

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* - Indicates a required field
Full Name *
If person is a minor, guardian's name
Date of Birth *
Address
Primary Phone Number *
If person is a minor, guardian's phone number
Email *
Who referred you to CHCS?
Preferred Location *
Preferred Provider *
Why are you seeking healthcare services?
What are your current health conditions?
What are your current prescription and non-prescription medications?
Do you have any drug or food allergies? If so, please list them
If you are requesting obstetrical (OB-GYN) care:
What was the first day of your last menstrual period?

What is your estimated delivery date?
Have you ever been to one of our facilities before? If so, when?
Who is the most recent doctor or medical provider you have seen for your healthcare needs?
By typing my initials, I attest that the above information is accurate *
Please be sure to bring a driver's license and insurance card(s) to your appointment

Community HealthCare System
Address: 120 W. 8th St., Onaga, KS
785-889-4241
785-889-4749

606 1st St.
Centralia, KS 66415
785-857-3334
785-857-3397

Hours:
Mon-Fri: 8 a.m. to 5 p.m.

6221 5th St.
Corning, KS 66417
785-868-2000
n/a

Hours:
Tues: 4 to 7 p.m.

112 E. 2nd St.
Frankfort, KS 66427
785-292-4451
785-292-4286

Hours:
Mon, Wed and Thurs: 8 a.m. to 5 p.m.

Tues: 8 a.m. to 7 p.m.
Fri: 7:30 a.m. to 3 p.m.

1603 W. 4th St.
Holton, KS 66436
785-364-3205
785-364-3468

Hours:
Mon-Thurs: 7 a.m. to 7 p.m.
Fri: 7 a.m. to 6 p.m.
Sat: 8 a.m. to 12 p.m.

120 W. 8th St.
Onaga, KS 66521
785-889-4241
785-889-4749

Hours:
Mon-Fri: 7 a.m. to 5 p.m.
Sat: 8:30 a.m. to 11 a.m.

206 Grand Ave.
St. Marys, KS 66536
785-437-3734
785-437-6186

Hours:
Mond-Fri: 8 a.m. to 5 p.m.
Sat: 9 a.m. to 11 a.m.

302 Main St
Westmoreland, KS 66549
785-457-9890
785-457-9891

Hours:
Mon-Thurs: 8 a.m. to 5 p.m.
Fri: 8 a.m. to 4 p.m.