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New Patient Forms

When you arrive for your appointment, we will ask you to complete the appropriate forms (see forms below). To make your visit easier, please feel free to download and complete the forms and bring them with you when you come to Family Healthcare of Hagerstown.

Staff are happy to help you apply for the Sliding Fee Program; this program is based on household income and can cover costs related to care at the Center. We can also connect you to area agencies that provide enrollment assistance for insurance through Maryland Health Connection and Medicaid. Need other kinds of assistance like housing, transportation, or clothing? If so, ask to speak with one of our Outreach Workers!

Located in the City of Hagerstown in semi-rural Washington County of Western Maryland, Family Healthcare of Hagerstown (FHH) is a private, non-profit community health center providing quality healthcare services for families and individuals at every life stage.

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Walnut Street Community Health Center, Inc. does business as Family Healthcare of Hagerstown (FHH). This health center receives funding through Health and Human Services (HHS) and is a grantee under 42 U.S.C. 254b. The health center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2.1 million with 70 percentage financed with nongovernmental sources. The contents of this website are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. FHH has Federal Public Health Services (PHS) deemed status related to certain health or health-related claims under 42 U.S.C. 233(g)-(n). This includes medical malpractice claims for itself and its covered individuals. FHH is a nonprofit organization under section 501(c)3 of the IRS Code. This institution is an equal opportunity provider and employer.

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New Patient Forms

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