Download Financial Assistance Form
Download Community Health Pharmacy
Prescription Form
Download our Patient Bill of Rights
Download our Demographic Information Form
Substance Use Treatment and Mental Health Information Release Form
Medical Record Release of Information Form
500.332D Statement of Disagreement of Denial to Release PHI Form
500.332E Request for Amendment Correction of PHI Form
500.332G Request for Accounting of Disclosure Request Form
500.332H Request For Specified Method of Communication Form
500.332I Request For Restricitions on Protected Health Information Form
Community Health Services of Lamoille Valley (CHSLV) is funded in part through a grant from the U.S. Health and Human Services Administration and generous community support. CHSLV is a Health Center Program grantee under 42 U.S.C. 254b and a deemed Public Health Service employee under 42 U.S.C. 233
This health center receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.
Providing compassionate care for everyone includes keeping our community safe and informed. We understand you and your loved ones may have concerns about the novel coronavirus, COVID-19.
Do your part to prevent the spread of COVID-19 and seasonal illnesses by washing your hands frequently with soap and water and by avoiding touching your eyes, nose, and mouth. For more information about symptoms, how to limit your risk, and the latest news, please visit the Vermont Department of Health or Centers for Disease Control and Prevention websites.
If you have concerns about an upcoming appointment, are experiencing flu-like symptoms, or just have specific questions, please call your CHSLV provider.
Together, we can reduce our risk and keep our community healthy!