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Schenectady 518.370.1441 Amsterdam 518.627.2110

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Hometown Health Centers, Schenectady

SCHOOL-BASED HEALTH CENTER REGISTRATION

STUDENT INFORMATION
PARENT/GUARDIAN INFORMATION

Contact Information for parent or guardian

Who is the student’s regular doctor?

INSURANCE INFORMATION

If your child does not have health insurance, would you like to be contacted by a Hometown Health Centers Enrollment Specialist who can assist you with obtaining free or low-cost health insurance?

HOMETOWN HEALTH ADMINISTRATIVE USE

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Services

Medical   |   Dental   |  Behavioral Health  |  Vision  |   School Based